Malabsorption
ICD-10 K90.9 · ICD-11 DA96.0

Severe Malabsorption with Diarrhoea: What to Do When Loperamide Fails to Reduce Gastrointestinal Fluid Losses

Clinical Scenario

This protocol is for patients with severe malabsorption — including those with intestinal insufficiency or intestinal failure — who have persistent diarrhoea and significant ongoing gastrointestinal fluid losses.

Prior Line: Goals Not Achieved

The previous treatment used loperamide, titrated in a stepwise manner, with the aim of reducing gastrointestinal fluid losses and faecal wet weight output.

This protocol applies when that approach has not adequately achieved those targets — diarrhoea and fluid losses remain insufficiently controlled despite loperamide escalation.

Next-Line Approach (Partial Preview)

In severe cases where single-agent antimotility therapy has been insufficient, the protocol specifies a combination antimotility regimen. The full agent selection, sequencing, and rationale are detailed in the structured protocol.

Goal: Reduce GI fluid losses & faecal wet weight output
Instant Access to Structured Evidence-Based Regimens

References

  1. Antimotility drugs (e.g., loperamide, diphenoxylate, codeine, opium tincture, octreotide) may be useful in patients with severe malabsorption such as intestinal insufficiency, to reduce gastrointestinal fluid losses.
  2. In severe cases of diarrhoea, a combination of loperamide and codeine may be useful.
  3. The use of antimotility drugs, mainly loperamide and codeine, is widespread in patients with IF or intestinal insufficiency and aims at reducing water and electrolyte losses in the stool.
View source ↗