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The basic principle for the treatment of idiopathic diarrhoea (functional diarrhoea K59.1) is to delay transit through the gut in order to promote the absorption of electrolytes and water. Under mild conditions, bulking agents may suffice. With increasing severity, antidiarrhoeal pharmaceuticals may be added in a stepwise manner. In diarrhoea of unknown aetiology, peripherally-acting opioid receptor agonists, such as loperamide, are first-line treatment and forms the pharmaceutical basis of antidiarrheal treatment. As second-line treatment opium drops have an approved indication for severe diarrhoea when other treatment options fail. Beyond this, various treatment options are built on experience with more advanced treatments using clonidine, octreotide, as well as GLP-1 and GLP-2 analogs which require specialist knowledge the field.

The basic principle for treatment of idiopathic diarrhea is to delay transit through the gut in order to promote absorption of electrolytes and water. Under mild conditions bulking agents may suffice. With increasing severity, antidiarrheal pharmaceuticals may be added in a stepwise manner. Bile salt malabsorption is a clear indication for adsorptive resins, while in idiopathic diarrhea peripherally-acting opioid receptor agonists, such as loperamide, is the first-line treatment. Second-line treatment with approved indication for severe diarrhea when other treatment options fail includes opium drops. More advanced treatments are to be used by clinicians with specialist knowledge and experience in the field., Kronisk diarré är vanligt och förekommer hos 5 pro cent av befolkningen. Diagnostiken är ofta en utma ning, och behandling måste ofta initieras utan att sä ker orsak har konstaterats. Målsättningen med denna artikel är att ge rekommendationer om farmakologis ka behandlingssteg vid diarré. Det är viktigt att hålla i minnet att diarré kan ha olika innebörd för olika indi vider, från osäkerhet och rädsla för ofrivillig tömning till återkommande inkontinens. Det innebär alltid en påtagligt sänkt livskvalitet.

Aim: To develop, evaluate and apply diagnostic methods for H. pylori infection. Materials and Methods: An in-house Urea Breath Test (UBT) was developed and evaluated in three different settings, using serology by ELISA and immunoblot as gold standard. Further, the Heliprobe was evaluated as an alternative diagnostic device. The UBT results in both studies were evaluated on consecutive patients referred to UBT due to either primary H. pylori screening or posttreatment evaluation. Sera from Swedish and Vietnamese patients and population control were used to compare the diagnostic performance of commercially available diagnostic kits and an inhouse ELISA. Luminal gastric nitric oxide (NO) was measured during endoscopy sessions along with biopsies harvested for histology and culture assessment. Sera were drawn for ELISA and immunoblot to establish H. pylori virulence factor status. H. pylori infection and gastrointestinal haemorrhage in patients with bleeding disorders in Sweden and Estonia was investigated. Diagnostic serology followed by UBT was used for screening purposes. All infected patients received eradication treatment, and were evaluated for gastrointestinal bleeding, comparing the five years prior to eradication with the ensuing 3.3 years. The costs involved with H. pylori screening, eradication and gastrointestinal bleeding events were determined. Results: The inhouse UBT was refined with reduced amount of radioactivity and the use of citric acid to enhance accuracy. The sensitivity and specificity was 93% and 100% respectively. The Heliprobe test results displayed 100% concordance with the in-house UBT. The in-house ELISA showed a significantly better performance if based on local strains. Due to lower antibody titres in Asian asymptomatic infected patients the kits required adjustment of cut-off limits for screening and seroepidermological purposes. The luminal gastric levels of NO were significantly increased in H. pylori infected patients as compared to