Review: Management of postprandial diarrhea syndrome

Mary E. Money, Michael Camilleri

Research output: Contribution to journalReview article

17 Scopus citations

Abstract

Unexpected, urgent, sometimes painful bowel movements after eating are common complaints among adults. Without a clear etiology, if pain is present and resolves with the movements, this is usually labeled "irritable bowel syndrome-diarrhea" based solely on symptoms. If this symptom-based approach is applied exclusively, it may lead physicians not to consider treatable conditions: celiac disease, or maldigestion due to bile acid malabsorption, pancreatic exocrine insufficiency, or an a-glucosidase (sucrase, glucoamylase, maltase, or isomaltase) deficiency. These conditions can be misdiagnosed as irritable bowel syndrome-diarrhea (or functional diarrhea, if pain is not present). Limited testing is currently available to confirm these conditions (antibody screens for celiac disease; fecal fat as a surrogate marker for pancreatic function). Therefore, empirical treatment with alpha amylase, pancreatic enzymes, or a bile acid-binding agent may simultaneously treat these patients and serve as a surrogate diagnostic test. This review will summarize the current evidence for bile acid malabsorption, and deficiencies of pancreatic enzymes or a-glucosidases as potential causes for postprandial diarrhea, and provide an algorithm for treatment options.

Original languageEnglish (US)
Pages (from-to)538-544
Number of pages7
JournalAmerican Journal of Medicine
Volume125
Issue number6
DOIs
StatePublished - Jun 1 2012

Keywords

  • Bile acid malabsorption
  • Disaccharidase deficiency
  • Functional diarrhea
  • Glucosidase deficiency
  • Glucosidase inhibition
  • Irritable bowel syndrome
  • Maldigestion
  • Pancreatic insufficiency
  • Postprandial diarrhea
  • Trigger foods

ASJC Scopus subject areas

  • Medicine(all)

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