What is the management approach for nonspecific enteritis?

From the Guidelines

The management of nonspecific enteritis should primarily focus on supportive care, including oral rehydration therapy and dietary modifications, as most cases are self-limiting viral infections that resolve with supportive measures. The approach to managing nonspecific enteritis can be guided by the principles outlined in the management of diarrhea in adult cancer patients, which emphasizes the importance of oral hydration and loperamide for patients with grade 1 or 2 diarrhea without complicating signs or symptoms 1.

Key Components of Management

• Oral rehydration therapy with balanced electrolyte solutions to prevent dehydration
• Dietary modifications, such as eliminating lactose-containing products and high-osmolar dietary supplements, and progressing to a clear liquid diet or the BRAT diet (bananas, rice, applesauce, toast) as symptoms improve
• Loperamide may be considered for symptom control in non-febrile, non-bloody diarrhea, but its use should be cautious, especially in children under 12 and in cases of suspected bacterial infection, due to potential side effects as reported in older studies 1
• Probiotics, such as Lactobacillus GG or Saccharomyces boulardii, may help shorten the duration of illness
• Antibiotics are generally not recommended unless there is evidence of a specific bacterial infection

Considerations

• Patients should maintain adequate fluid intake (at least 2-3 liters daily) and avoid dairy products, caffeine, alcohol, and high-fat foods temporarily
• Medical attention should be sought if symptoms persist beyond 3-4 days, if there is a high fever, bloody stools, or signs of dehydration
• The role of dedicated supportive care services may be crucial in limiting hospitalization and allowing better control of symptoms, especially in complicated cases 1

Complicated Cases

• Patients with mild to moderate diarrhea complicated by moderate to severe cramping, nausea and vomiting, diminished performance status, fever, sepsis, neutropenia, bleeding, or dehydration, and those with severe diarrhea, should be hospitalized, evaluated further, monitored closely, and intensively treated 1

From the FDA Drug Label

Loperamide hydrochloride capsules are indicated for the control and symptomatic relief of acute nonspecific diarrhea in patients 2 years of age and older and of chronic diarrhea in adults associated with inflammatory bowel disease. The management approach for nonspecific enteritis may involve the use of loperamide for the control and symptomatic relief of acute nonspecific diarrhea in patients 2 years of age and older, as it is indicated for this purpose 2.

• The use of loperamide is limited to the relief of diarrhea symptoms.
• It is essential to note that nonspecific enteritis may require a more comprehensive management approach, but according to the provided drug label, loperamide can be used for symptomatic relief of diarrhea.

From the Research

Management Approach for Nonspecific Enteritis

The management of nonspecific enteritis involves a combination of supportive care, fluid and electrolyte replacement, and pathogen-specific treatments when relevant and available.

• Fluid and Electrolyte Replacement: The primary goal in managing nonspecific enteritis is to prevent dehydration and correct fluid and electrolyte imbalances 3, 4, 5. Oral rehydration solutions (ORSs) and intravenous fluids (IVFs) are the mainstays of treatment for patients with dehydration due to diarrhea.
• Supportive Care: Supportive care, including nutritional support for neonates, is essential in managing enteritis 6, 7. This involves providing a nutritionally balanced diet and ensuring that the patient is well-hydrated.
• Pathogen-Specific Treatments: Antimicrobial agents are indicated for specific types of enteric infections, such as shigellosis, cholera, and giardiasis 5. However, their use should be judicious to avoid contributing to the escalating prevalence of bacterial resistance worldwide.
• Adjunctive Treatments: Few adjunctive treatments provide proven benefit without risk of adverse reactions 5. Most offer no advantage over placebo, and their general use is not encouraged.
• Multidisciplinary Approach: A multidisciplinary approach, including a dietitian, medical provider, pharmacist, and others, is crucial to create a collaborative and comprehensive look at a complicated patient to individualize treatment options 4.

Treatment Options

Treatment options for nonspecific enteritis include:

• Loperamide and diphenoxylate/atropine, which are conditionally recommended to be used in critically ill patients with acute noninfectious diarrhea 6
• Oral rehydration solutions (ORSs) and intravenous fluids (IVFs) to maintain fluid balance and combat dehydration 3, 4
• Antimicrobial agents for specific types of enteric infections 5
• Supportive care, including nutritional support for neonates 6, 7