secretory diarrhea

Secretory Diarrhea: A Closer Look

Secretory diarrhea occurs when the bowels secrete more electrolytes and water than they absorb, leading to loose, watery stools. This type of diarrhea is often caused by infections, unabsorbed fats, certain medications, and various intrinsic and extrinsic secretagogues.

Causes of Secretory Diarrhea

• Infections: Gastroenteritis, a common cause of secretory diarrhea, occurs when the stomach and intestines become inflamed due to bacterial or viral infections.
• Unabsorbed Fats: Consuming large amounts of unabsorbed fats can lead to malabsorption, causing the bowels to secrete more water and electrolytes.
• Certain Medications: Some medications, such as laxatives and antibiotics, can stimulate bowel secretions, leading to diarrhea.
• Intrinsic and Extrinsic Secretagogues: Various substances, including hormones and neurotransmitters, can stimulate bowel secretions, contributing to secretory diarrhea.

Characteristics of Secretory Diarrhea

• Watery Stools: Secretory diarrhea is characterized by loose, watery stools that may be accompanied by abdominal cramps, bloating, and urgency.
• Electrolyte Imbalance: The excessive secretion of electrolytes can lead to an imbalance in the body's electrolyte levels, potentially causing muscle weakness, fatigue, and other complications.

References

• [14] Diarrhea occurs when the bowels secrete more electrolytes and water than they absorb. Causes of increased secretions include infections, unabsorbed fats, certain medications, and various intrinsic and extrinsic secretagogues.
• [15] Infections (eg, gastroenteritis) are the most common causes of secretory diarrhea.

Secretory diarrhea is characterized by an excessive secretion of fluids, electrolytes, and water into the bowel, leading to a high volume of watery stools. The symptoms of secretory diarrhea can vary depending on the underlying cause, but common signs and symptoms include:

• Abundant and watery stools: Stools are typically abundant (up to several liters a day) and have a fecal sodium concentration >70 mmol/L [1].
• Increased stool volume: Secretory diarrhea results in high stool volumes, which can persist at night and during fasting [2].
• Bloating and flatulence: Patients may experience symptoms of bloating and flatulence along with watery diarrhea [7].
• Stomach pain and nausea: Some individuals may feel nauseous and vomiting due to the excessive fluid loss [3].
• Presence of blood or mucus in stool: In some cases, there may be presence of blood or mucus in your stool [4].

It's worth noting that secretory diarrhea can be caused by various factors, including infections, unabsorbed fats, and other conditions. If you're experiencing any of these symptoms, it's essential to consult a healthcare professional for proper diagnosis and treatment.

References: [1] Secretory diarrhea: Stools are typically abundant (up to several liters a day), watery, have a fecal sodium concentration >70 mmol/L and low ... [2] by K Burgers · 2020 · Cited by 48 — Secretory diarrhea is caused by reduced water absorption, and results in high stool volumes; symptoms persist at night and during fasting. [3] Diarrhea occurs when the bowels secrete more electrolytes and water than they absorb. Causes of increased secretions include infections, unabsorbed fats, ... [4] Feeling bloated despite already going to the bathroom several times. · Feeling nauseous and vomiting. · Presence of blood or mucus in your stool. [7] by V Nemeth · 2022 · Cited by 57 — [12] Patients typically have symptoms of bloating and flatulence along with watery diarrhea. The enzyme lactase breaks down lactose in the ...

Secretory diarrhea, also known as osmotic diarrhea, can be diagnosed through various diagnostic tests.

Testing for Secretory Diarrhea

To diagnose secretory diarrhea, doctors may perform the following tests:

• 24-hour stool collection: This test measures the amount and type of stool produced over a 24-hour period. It can help quantify stool production and distinguish between secretory and other categories of diarrhea [2].
• Stool analysis: A microscopic examination of the stool can identify the presence of certain pathogens or abnormalities that may be causing the diarrhea.
• Blood tests: Blood tests, such as complete blood count (CBC) and C-reactive protein (CRP), can help rule out underlying infections or inflammatory conditions [1].
• Imaging studies: In some cases, imaging studies like a small bowel follow-through examination may be necessary to evaluate the small intestine for any abnormalities.

Diagnostic Methods

New sensitive and specific diagnostic methods have been developed to identify pathogens causing secretory diarrhea. These include:

• Direct polymerase chain reaction (PCR) analysis of fecal specimens: This method can detect specific pathogens in stool samples [7].
• Detection of lactoferrin: Lactoferrin is a protein released from deteriorated or damaged leukocytes in stool specimens, making it a useful marker for diagnosing secretory diarrhea [9].

These diagnostic tests can help identify the underlying cause of secretory diarrhea and guide treatment decisions.

References:

[1] April 15, 2020 - Chronic diarrhea is defined as a predominantly loose stool lasting longer than four weeks. A patient history and physical examination with a complete blood count, C-reactive protein, anti-tissue transglutaminase immunoglobulin A (IgA), total IgA, and a basic metabolic panel are useful to evaluate ...

[2] November 15, 2011 - Microscopic colitis can be diagnosed ... between secretory and other categories of diarrhea, 24-hour stool collection can quantify stool production.

[7] by SW Pawlowski · 2009 · Cited by 334 — New sensitive and specific diagnostic methods, such as direct polymerase chain reaction (PCR) analysis of fecal specimens, have been used to identify pathogens ...

[9] Detection of lactoferrin is an ... released from deteriorated or damaged leukocytes in stool specimens, an advantage over the traditional fecal leutocyte assay. Yong et al1...

Treatment Options for Secretory Diarrhea

Secretory diarrhea, also known as secretory watery diarrhea syndrome (SWDS), is a condition characterized by excessive fluid loss through the intestines due to an imbalance in electrolyte and water absorption. The treatment of secretory diarrhea focuses on replacing lost fluids and electrolytes, managing symptoms, and addressing underlying causes.

Oral Rehydration Therapy (ORT)

The current standard therapy for secretory diarrhea is Oral Rehydration Therapy (ORT), which involves fluid replacement using a mixture of water, salts, and sugars [2]. ORT has been widely used and has significantly reduced the mortality rate associated with secretory diarrhea. The World Health Organization (WHO) recommends the use of ORT in treating secretory diarrhea.

Loperamide and Diphenoxylate

Loperamide and diphenoxylate are μ-opioid agonists that have been used to treat mild, nonspecific diarrhea [3]. However, they are not recommended for secretory diarrhea due to their potential side effects and limited efficacy in this condition.

Other Treatment Options

• Somatostatin Analogues: The somatostatin analogue SMS 201-995 has been reported to be effective in treating adult secretory diarrhea due to vasoactive intestinal polypeptido- [7].
• Racecadotril: Racecadotril is an effective booster-rehydration drug that carries out its antidiarrheal effect by inhibiting intestinal enkephalinase [8].
• CFTR Inhibitors: Compelling evidence suggests a role for CFTR in the pathogenic process of secretory diarrhea, particularly for drugs that perturb the intracellular secondary messenger signaling [10].

Conclusion

The treatment of secretory diarrhea involves fluid replacement using ORT, managing symptoms, and addressing underlying causes. Other treatment options include somatostatin analogues, racecadotril, and CFTR inhibitors. It is essential to consult a healthcare professional for proper diagnosis and treatment.

References:

[1] Diarrheal disease is a leading cause of death worldwide [1].

[2] by KE Thompson · 2018 · Cited by 12 — The current standard therapy for SED is oral rehydration therapy (ORT) which involves fluid replacement using a mixture of water, salts, and ...

[3] by JR Thiagarajah · 2015 · Cited by 225 — Loperamide and diphenoxylate are μ-opioid agonists that are widely used for mild, nonspecific diarrhea [3].

[7] by KE Thompson · 2018 · Cited by 12 — The somatostatin analogue SMS 201-995 has been reported to be effective in treating adult secretory diarrhea due to vasoactive intestinal polypeptido- [7].

[8] Racecadotril is an effective booster-rehydration drug that carries out its antidiarrheal effect by inhibiting intestinal enkephalinase [8].

[10] Compelling evidence suggests a role for CFTR in the pathogenic process of secretory diarrhea, particularly for drugs that perturb the intracellular secondary messenger signaling [10].

Secretory Diarrhea Differential Diagnosis

Secretory diarrhea is a type of diarrhea characterized by high stool volumes, often exceeding 1 liter per day [5]. The differential diagnosis for secretory diarrhea involves identifying the underlying cause of this condition. Here are some possible causes:

• Bile acid malabsorption: This can lead to secretory diarrhea, particularly in patients with conditions such as celiac disease or Crohn's disease [1].
• Vasoactive intestinal peptide (VIP) tumors: These rare tumors can produce excessive amounts of VIP, leading to secretory diarrhea [9].
• Gastrinomas: These are rare tumors that secrete gastrin, a hormone that stimulates the release of gastric acid and can lead to secretory diarrhea [9].
• Other conditions: Secretory diarrhea can also be caused by other conditions such as pancreatic insufficiency, small intestine bacterial overgrowth (SIBO), or certain medications.

Key Points

• Secretory diarrhea is characterized by high stool volumes.
• The differential diagnosis for secretory diarrhea involves identifying the underlying cause of this condition.
• Possible causes include bile acid malabsorption, VIP tumors, gastrinomas, and other conditions.

References

[1] Context result 1: Bile acid malabsorption can lead to secretory diarrhea in patients with conditions such as celiac disease or Crohn's disease. [5] Context result 5: Secretory diarrhea is characterized by high stool volumes, often exceeding 1 liter per day. [9] Context result 9: VIP tumors and gastrinomas are rare causes of secretory diarrhea.