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Wednesday, 4 December 2013

Enteritis - Treatments In conventional medicine perspective

Acute Enteritis, in most cases is defined as a condition of inflammation of the small intestine as a result of eating and drinking contaminated water and foods infected by virus and bacteria. But according to the study by the University Hospital Aintree, chronic radiation enteritis is an increasing problem, as more patients receive radiotherapy as part of their cancer therapy and as the long-term survival of these patients improves(a). Other study indicated that acute radiation enteritis is almost inevitable in the curative treatment of malignant tumors of the abdomen and pelvic area. It is frequently a self-limiting disorder of intestinal function associated with reversible mucosal changes of the intestine(b). The prevalence of the disease although is decreasing, it still affects millions (approx 1 in 83 or 1.20% or 3.3 million people in USA ) of people in the U.S alone, according to the statistic. Chronic enteritis is a condition of inflammation caused by other health conditions, such as Crohn's or celiac disease.
Treatments
A. In conventional medicine perspective
Treatment depending to the underlined causes of the diseases.
Beside taking certain steps in relieving the symptoms of the patients by providing short-lived and  general supportive care(49), such as
Oral rehydration therapy for older children and adults:

  • Drink clear liquids only, such as water, sports drinks (best), fruit juice and dilute tea.
  • Drink small quantities of fluids frequently, such as 2 tablespoons of fluid every 5 minutes.
  • The absence of food allows the intestines to rest.
  • May be able to advance to full liquid diet once symptoms improve
  • Effective to treat mild to moderate dehydration
  • Intravenous fluids for severe dehydration
  • Clear liquid diet
  • BRAT diet (i.e. bananas, rice, applesauce, toast)
  • But according to the study by the Christiana Care Health System, probiotics reduce diarrheal duration from a number of etiologies. Professional nursing practice based on evidence and clinical expertise supports a diet-containing probiotics to manage acute diarrhea. Dietary limitations included in the BRAT (bananas, rice, applesauce, and toast) diet recommended by many nurses need to be reexamined in light of the newest evidence(48a).
  • Medications for nausea and vomiting:

    • Metoclopramide (Reglan) but side effects are not limit to hives, difficulty breathing, swelling of your face, lips, tongue, or throat.
    • Ondansetron (Zofran) but side effects are not limit to headache, fatigue, constipation, etc.
    • Olanzapine has been shown to be a safe and effective agent for the prevention of  nausea and vomiting  for patient with entertitis, but side effects are not limit to  hives; difficulty breathing; swelling, etc.
    • Prochlorperazine (Compazine, Compro) but side effects are not limit to Constipation, headaches, dizziness, etc.




  • Medications for diarrhea:

    • Loperamide (Imodium) but side effects are not limit to abdominal pain, constipation, drowsiness, dizziness, dry mouth, fatigue, nausea, vomiting, etc.
    • Diphenoxylate and Atropine (Lomotil) but side effects are not limit to thirst, decreased urination, muscle cramps, weakness, fainting, etc.
    A.1. Bacterial entertitis
    Atibiotic used are depending to types infectous organism, including Ciprofloxacin (Cipro),  Sulfamethoxazole and Trimethoprim (Bactrim, Septra, TMP-SMX),  Ceftriaxone (Rocephin) Cefotaxime (Claforan) Vancomycin (Vancocin, Lyphocin, etc., but side effects are not limit to rash, diarrhea, abdominal pain, nausea/vomiting, drug fever, hypersensitivity (allergic) reactions, etc.
    According to the study by Enterics laboratory, US Army Research Unit, Nairobi, in screening of the 651 patients screened, the highest prevalence of antimicrobial resistance was to ampicillin followed by trimethoprim/sulphamethoxazole and tetracycline. Though still at low levels, the major concern from our findings is the emerging resistance of enteric pathogens that was observed to quinolones (ciprofloxacin, nalidixic acid, norfloxacin) and gentamycin(49a).


    A.2. Viral entertitis
    There is no specific treatment for viral entertistis as antibiotic are not helpful in treating the diseasse. Make sure you are vaccinate against certain virus in a specific season.
    According to the study by Beijing Friendship Hospital Affiliate of Capital University of Medical Sciences,  clinical effective rate of Novalac AD in infantile rotavirus enteritis was 100%. All 20 subjects stool turned normal and systemic symptoms disappeared after treatment, with 17 within 48 h (85%,17/20) and 3 within 72 h (15%, 3/20)(50).

    A.3. Radiation-induced enteritis
    Radiation-induced enteritis van be prevented, according to the University Hospital Mannheim, Reduction of radiation dose and field size are still the most important factors in the prevention of acute and chronic radiation enteritis. Valid data particularly on the treatment of chronic radiation enteritis are lacking. A better understanding of the pathopysiology especially in chronic radiation enteritis might offer new therapeutic perspectives. Inhibition of TGF-beta, for example, might be a new promising therapy approach(50a).
    According to the study the Provincial Hospital affiliated to Shandong University, in the evaluation of the effect of actovegin (Nycomed, deproteinized hemoderivative of calf blood injection) on intestinal mucosa in rats with acute radiation enteritis, and observe the changes of expression of apoptosis-related bcl-2/bax genes, showed that Actovegin accelerates the recovery of the acute radiation-injured intestinal mucosal epithelium by decreasing apoptosis via down-regulation of the expression of activating apoptosis protein bax and up-regulation of inhibiting apoptosis protein bcl-2(51).
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    Sources
    (a) http://www.ncbi.nlm.nih.gov/pubmed/19897345
    (b) http://www.ncbi.nlm.nih.gov/pubmed/3310287  
    (48) http://www.ncbi.nlm.nih.gov/pubmed/10821115
    (48a) http://www.ncbi.nlm.nih.gov/pubmed/22517350
    (49) http://www.freemd.com/bacterial-enteritis/treatment.htm
    (49a) http://www.ncbi.nlm.nih.gov/pubmed/22842944
    (50) http://www.ncbi.nlm.nih.gov/pubmed/21110440
    (50a) http://www.ncbi.nlm.nih.gov/pubmed/18461520
    (51) http://www.ncbi.nlm.nih.gov/pubmed/20021825