Baldi Fabio, Bianco Maria Antonia, Nardone Gerardo, Pilotto Alberto, Zamparo Emanuela
Gastroenterology Unit, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy.
World J Gastroenterol. 2009 Jul 21;15(27):3341-8. doi: 10.3748/wjg.15.3341.
Diarrhoea is an alteration of normal bowel movement characterized by an increase in the water content, volume, or frequency of stools. Diarrhoea needs to be classified according to the trends over time (acute or chronic) and to the characteristics of the stools (watery, fatty, inflammatory). Secretory diarrhoeas, mostly acute and of viral aetiology in more than 70% of cases, are by far the most important subtype of diarrhoeas in terms of frequency, incidence and mortality (over 2.5 million deaths/year in developing countries). Natural and synthetic opiates such as morphine, codeine, and loperamide which react with endogenous opiates (enkephalins, beta-endorphins, dynorphins) mainly act on intestinal motility and slow down transit. An antidiarrhoeal drug developed in recent years, racecadotril, acts as an enkephalinase inhibitor. Clinical studies have shown that it is just as effective as loperamide in resolving acute diarrhoea but with greater reduction in pain and abdominal distension. Some studies have explored the prevalence of diarrhoea in old age. An epidemiological study carried out in Italy by 133 General Practitioners on 5515 elderly outpatients reported a prevalence of diarrhoea, defined according to the Rome criteria, of 9.1%. Infectious diseases (19%) and drug use (16%) were the most common causes of diarrhoea in old age. Regardless of the cause, the treatment of elderly patients with diarrhoea must include rehydration and nutritional support. Every year, more than 50 million tourists travel from industrialized countries to places where hygiene levels are poor. At least 75% of those travelling for short periods mention health problems, and in particular traveller's diarrhoea.
腹泻是正常排便的一种改变,其特征是粪便含水量、体积或排便频率增加。腹泻需要根据时间趋势(急性或慢性)以及粪便特征(水样、脂肪样、炎症性)进行分类。分泌性腹泻大多为急性,70%以上病例由病毒病因引起,就发生率、发病率和死亡率而言(发展中国家每年超过250万例死亡),它是迄今为止腹泻最重要的亚型。天然和合成阿片类药物,如吗啡、可待因和洛哌丁胺,与内源性阿片类物质(脑啡肽、β-内啡肽、强啡肽)起反应,主要作用于肠道蠕动并减缓转运。近年来研发的一种止泻药物消旋卡多曲,作为脑啡肽酶抑制剂发挥作用。临床研究表明,它在缓解急性腹泻方面与洛哌丁胺同样有效,但能更大程度减轻疼痛和腹胀。一些研究探讨了老年人腹泻的患病率。133名全科医生在意大利对5515名老年门诊患者进行的一项流行病学研究报告,根据罗马标准定义的腹泻患病率为9.1%。传染病(19%)和药物使用(16%)是老年人腹泻最常见的原因。无论病因如何,老年腹泻患者的治疗必须包括补液和营养支持。每年有超过5000万游客从工业化国家前往卫生水平较差的地方。至少75%的短期旅行者提到有健康问题,尤其是旅行者腹泻。