1. HIGH VALUE CARE GI CONDITIONS CHRONIC DIARRHEA EDWARD LEVINE MD OSUWMC OCTOBER 11, 2014

3. HOW DO WE DEFINE DIARRHEA VOLUME OF STOOL? FREQUENCY OF STOOL? CONSISTENCY OF STOOL?

4. HOW DO WE APPROACH DIARRHEA  PATHOPHYSIOLOGY  ACUTE DIARRHEA  CHRONIC DIARRHEA  SMALL BOWEL  COLONIC

5. ACUTE DIARRHEA  CHRONIC DIARRHEA

6. CHRONIC DIARRHEA

7.  IBS  IBD  CELIAC DISEASE  COLLAGENOUS COLITIS  C DIFF

11. ? SIBO

12. MEDICAL RX FOR GAS  DIETARY RESTRICTIONS – LACTOSE FREE DIET, FRUCTOSE FREE DIET, GFD,FODMAP DIET  ENZYMES - BEANO  CHARCOAL  PROBIOTICS  ANTIBIOTICS

13. GAS EATER UNDERWEAR BUY AT WWW.UNDER-TEC.COM

18. EVALUATION FOR IBD  CBC, IRON STUDIES, CR, LFT’S, TSH, CRP, STOOL CULTURES  COLONOSCOPY  MRE/CTE  CAPSULE ENDOSCOPY

19. TREATMENT OF IBD

21. CELIAC DISEASE

25. COLLAGENOUS COLITIS

27. CLOSTRIDIUM DIFFICILE

28. FMT  NOT NEW!!!!!!!!!!!  FIRST DESCRIPTION FROM CHINA IN THE 4 TH CENTURY, INGESTION OF FECES RX’ED FOR A VARIETY OF CONDITIONS  “…CONSUMPTION OF FRESH, WARM, CAMEL FECES HAS BEEN RECOMMENDED BY BEDOUINS AS A REMEDY FOR BACTERIAL DYSENTERY; ITS EFFICACY WAS CONFIRMED BY GERMAN SOLDIERS IN AFRICA IN WWII  FIRST USE IN MAINSTREAM MEDICINE WAS IN 1958 TO TREAT C DIFF

29. FMT  DISTAL GI TRACT CONTAINS A DIVERSE ARRAY OF MICROORGANISMS, OF WHICH BACTERIA IS THE MOST DOMINANT WITH AT LEAST 1 X 10 14 TH BACTERIA, PREDOMINANTLY ANAEROBES WITH THOUSANDS OF DIFFERENT SPECIES, MANY OF WHICH HAVEN’T BEEN CULTURED  BACTERIA INTERACT WITH THE INTESTINAL MUCOSA IN A VARIETY OF WAYS

31. Diversity in Patients before and after Infusion of Donor Feces, as Compared with Diversity in Healthy Donors. van Els Van Nood et al. NEJM. 2013; 368:407- 415

32. without Relapse for Recurrent Clostridium difficile Infection. van Nood E et al. N Engl J Med 2013;368:407-415 Els Van Nood et al. NEJM. 2013; 368:407- 415

33. FMT  FMT FOR IBD  26 YO MALE WITH HX OF CROHN’S COLITIS, HX OF PERIANAL DISEASE  FAILED MESALAMINE, PDN, IMURAN  C DIFF NEG  INSURANCE CO DENIED BIOLOGICS  FMT TRIED AFTER IRB APPROVAL

36. DIARRHEA CASE OF REFRACTORY IBD  56 YO AMBULATORY MALE WITH UC ON IMURAN AND MESALAMINE. TREATED FOR PNEUMONIA WITH ATB’S. DEVELOPS SX OF UC REFRACTORY TO ORAL STEROIDS.  NEXT STEPS?