Functional Diarrhea When Rifaximin Has Not Resolved Loose or Watery Stools
This protocol addresses patients with functional diarrhea in whom an initial course of Rifaximin did not achieve the expected relief of loose or watery stools. When that first-line approach proves insufficient, the evidence supports a defined next-line strategy.
Previous line — goal not reached
Prior therapy: Rifaximin
Target not met: Relief of loose or watery stools
Next-Step Approach
After Rifaximin has not produced adequate improvement, the protocol calls for a trial of a bile acid sequestrant — a class of agent considered specifically in this setting when formal testing for bile acid diarrhoea has not been performed.
The complete protocol specifies agent selection, how to introduce treatment, and what to anticipate in terms of tolerability. The full details are one click away.
References
DOI: 10.1002/ueg2.12259
If testing is not available, a trial of a bile acid sequestrant should be considered in patients with persistent unexplained chronic diarrhoea.
Bile acid sequestrants include colestyramine, colestipol, and colesevelam.
Colestyramine has remained the usual first choice drug but is often poorly tolerated, sometimes because the drug is not introduced slowly, or because of its formulation.
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