Motility-related diarrhea
1) Motility-related diarrhea is caused by the rapid movement of food through the intestines (hypermotility). If the food moves too quickly through the GI tract, there is not enough time for sufficient nutrients and water to be absorbed. This can be due to a vagotomy or diabetic neuropathy, or a complication of menstruation. Hyperthyroidism can produce hypermotility and lead to pseudodiarrhea and occasionally real diarrhea. Diarrhea can be treated with antimotility agents (such as loperamide). Hypermotility can be observed in patients who have had portions of their bowel removed, allowing less total time for absorption of nutrients.
2) Treatment: In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth – oral rehydration therapy – or, in very severe cases, intravenously.
* Vagotomy
Applications: Truncal vagotomy is a treatment option for chronic duodenal ulcers. It was once considered the gold standard but is now reserved for patients who have failed the first-line "triple therapy" against Helicobacter pylori infection: 2 antibiotics (clarithromycin and amoxicillin or metronidazole) and a proton pump inhibitor (e.g. omeprazole). It is also used in the treatment of gastric outlet obstruction.
The use of vagotomy to treat obesity is being studied. Early results show an average of 18% weight loss. Vagotomy may have an impact upon ghrelin.
History: Vagotomy was once popular as a way of treating and preventing peptic ulcer disease and subsequent ulcer perforations. It was thought that peptic ulcer disease was due to excess secretion of the acid environment in the stomach, or at least that peptic ulcer disease was made worse by hyperacidity. Vagotomy was a way to reduce the acidity of the stomach, by denervating the peptic cells that produce acid. This was done with the hope that it would treat or prevent peptic ulcers. It also had the effect of reducing or eliminating symptoms of gastroesophageal reflux in those who suffered from it. The incidence of vagotomy decreased following the discovery by Barry Marshall and Robin Warren that H. pylori is responsible for most peptic ulcers, because H. pylori can be treated much less invasively.
* Diabetic neuropathy: GI tract manifestations include gastroparesis, nausea, bloating, and diarrhea. Because many diabetics take oral medication for their diabetes, absorption of these medicines is greatly affected by the delayed gastric emptying. This can lead to hypoglycemia when an oral diabetic agent is taken before a meal and does not get absorbed until hours, or sometimes days later, when there is normal or low blood sugar already. Sluggish movement of the small intestine can cause bacterial overgrowth, made worse by the presence of hyperglycemia. This leads to bloating, gas and diarrhea.
* Menstruation: Pain from menstrual cramps is a result of contractions of your uterus, which are caused by prostaglandins. Prostaglandins circulate in your bloodstream and they can cause diarrhea and gas because they also speed up contractions in your intestines.
* Hyperthyroidism: Thyroid hormone functions as a stimulus to metabolism and is critical to normal function of the cell. In excess, it both overstimulates metabolism and exacerbates the effect of the sympathetic nervous system, causing "speeding up" of various body systems and symptoms resembling an overdose of epinephrine (adrenaline). These include fast heart beat and symptoms of palpitations, nervous system tremor and anxiety symptoms, digestive system hypermotility (diarrhea), and weight loss.
