This page addresses the next step in managing severe malabsorption — presenting as intestinal insufficiency or intestinal failure — when diarrhoea and gastrointestinal fluid losses persist despite a first-line anti-diarrhoeal combination.
The patient has severe malabsorption characterised by intestinal insufficiency or intestinal failure, with ongoing diarrhoea and substantial gastrointestinal fluid losses. Anti-motility strategies are a recognised component of management in this setting.
A combination of loperamide and codeine was used as first-line therapy for severe diarrhoea. The treatment targets — reduction of gastrointestinal fluid losses and faecal wet weight output — were not adequately achieved, indicating the need for escalation.
The structured protocol for this situation targets a clinically meaningful reduction in gastrointestinal fluid losses and faecal wet weight output. The approach involves an agent with both anti-motility and anti-secretory properties, proposed specifically for severe, refractory cases — the full protocol details and selection criteria are available via the link below.
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.
Finally, in case of severe, refractory diarrhoea, octreotide has also been proposed, due to its anti-motility and anti-secretory effect.