Treatment of diarrhea in patients with inflammatory bowel disease: Concepts and cautions

Shamita B. Shah*, Stephen B. Hanauer

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations


Diarrhea continues to be a prevalent symptom in patients with inflammatory bowel disease (IBD), requiring a wide differential diagnosis to define the pathophysiologic mechanisms in individual patients. It is essential that physicians properly evaluate complaints of diarrhea by assessing both patient symptoms and potential physiologic impacts on fluid and electrolyte status. Underlying mechanisms of diarrhea with IBD are the location, extent, and severity of inflammation; malabsorption; altered motility; and iatrogenic causes such as medications, diet, and antibiotic-associated colitis (eg, Clostridium difficile). When treating diarrhea, physicians need to control inflammatory activity using appropriate treatment algorithms. Therapies include aminosalicylates, corticosteroids, immune modifiers, and, most recently, biologic treatment. Other medications, including loperamide, diphenoxylate, codeine sulfate, and tinctures of opium, slow motility and increase the absorption of fluids and nutrients. For iatrogenic issues, medications that cause diarrhea should be withdrawn and individual diets modified. Not all diarrheas in the IBD patient are the same; therefore, it is essential to tailor therapies according to presumed etiologies. Antidiarrheal agents are not recommended in extremely ill patients and those with known hypersensitivity or evidence of obstruction or colonic dilation, fever, or abdominal tenderness. Concomitant use of loperamide with diphenoxylate and atropine should be avoided in early pregnancy.

Original languageEnglish (US)
Pages (from-to)S3-S10
JournalReviews in gastroenterological disorders
Issue numberSUPPL. 3
StatePublished - 2007


  • Diarrhea
  • Inflammatory bowel disease
  • Loperamide
  • Malabsorption
  • Motility
  • Pathophysiologic mechanisms

ASJC Scopus subject areas

  • Gastroenterology


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