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Diarrhea is medically defined as the occurrence of at least three loose, liquid, or watery bowel movements within a single day, or a frequency of stools exceeding an individual's typical pattern.
Answer: True
The World Health Organization and American medical consensus define diarrhea as having at least three loose, liquid, or watery bowel movements within a single day, or more stools than is typical for an individual.
Persistent diarrhea is characterized by a duration exceeding one week and is invariably associated with bloody stools.
Answer: False
Persistent diarrhea is defined as lasting more than two weeks and can be either watery or bloody, not necessarily always bloody or limited to one week.
Dysentery represents a distinct form of diarrhea, identified by the macroscopic presence of blood in the stools, which signifies an invasion of the intestinal tissue.
Answer: True
Dysentery is indeed characterized by visible blood in the stools, indicating an invasive process within the bowel tissue, often caused by pathogens like *Shigella*.
The etymology of 'diarrhea' traces to Latin, signifying 'rapid flow'.
Answer: False
The word 'diarrhea' originates from Ancient Greek, combining 'dia' (through) and 'rheo' (flow).
The World Gastroenterology Organization defines acute diarrhea as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel that lasts for less than 14 days.
Answer: True
The World Gastroenterology Organization defines acute diarrhea as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel that lasts for less than 14 days.
According to the World Health Organization, what constitutes the medical definition of diarrhea?
Answer: Having more stools than is typical for an individual, or at least three loose, liquid, or watery bowel movements within a single day.
The World Health Organization defines diarrhea as having more stools than is typical for an individual, or at least three loose, liquid, or watery bowel movements within a single day.
Which of the following is NOT recognized as one of the three primary classifications of diarrhea based on its duration and clinical characteristics?
Answer: Chronic inflammatory diarrhea
The three primary classifications of diarrhea based on duration and characteristics are short duration watery diarrhea, short duration bloody diarrhea, and persistent diarrhea. Chronic inflammatory diarrhea is a type of cause, not a primary classification.
Dysentery is clinically defined by the macroscopic presence of blood in the stools and can be etiologically linked to which of the following pathogens?
Answer: *Shigella*
Dysentery is characterized by the visible presence of blood in the stools and can be caused by pathogens such as *Shigella*, *Entamoeba histolytica*, and *Salmonella*.
From which classical language does the term 'diarrhea' derive its etymological roots?
Answer: Ancient Greek
The word 'diarrhea' originates from Ancient Greek, specifically from 'διάρροια'.
According to the World Gastroenterology Organization, what is the precise definition of acute diarrhea?
Answer: An abnormally frequent discharge of semisolid or fluid fecal matter from the bowel that lasts for less than 14 days.
The World Gastroenterology Organization defines acute diarrhea as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel that lasts for less than 14 days.
Secretory diarrhea is principally caused by pathologies involving structural damage to the intestinal mucosa.
Answer: False
Secretory diarrhea occurs due to increased active secretion or inhibited absorption, with minimal to no structural damage to the bowel. It is often caused by toxins, such as cholera toxin.
Osmotic diarrhea results from the influx of an excessive volume of water into the intestinal lumen, frequently precipitated by the presence of unabsorbed solutes such as undigested lactose.
Answer: True
Osmotic diarrhea is characterized by the movement of excessive water into the bowels, typically driven by osmotically active, unabsorbed substances like undigested lactose or excess fructose.
Exudative diarrhea is defined by the presence of blood and pus in the stool and is commonly linked to inflammatory bowel diseases.
Answer: True
Exudative diarrhea is indeed characterized by blood and pus in the stool, and it is typically associated with inflammatory bowel diseases or severe enteric infections.
Inflammatory diarrhea arises from damage to the intestinal mucosal lining, leading to a passive efflux of protein-rich fluids.
Answer: True
Inflammatory diarrhea is caused by damage to the mucosal lining or brush border of the intestines, resulting in a passive loss of protein-rich fluids and impaired fluid reabsorption.
The fundamental physiological process underlying diarrhea is the small intestine's inability to adequately reabsorb water.
Answer: False
The fundamental physiological process leading to diarrhea is the large intestine's inability to sufficiently reabsorb water and other digestive fluids from fecal matter.
Malabsorption is predominantly caused by pathologies affecting the large intestine.
Answer: False
Malabsorption is primarily due to disorders in the small bowel or maldigestion from pancreatic diseases, not the large bowel.
Nesse and Williams posited that diarrhea may serve as an evolved expulsion defense mechanism.
Answer: True
Researchers Nesse and Williams proposed that diarrhea might function as an evolved expulsion defense mechanism, suggesting that its suppression could delay recovery.
The small intestine bears primary responsibility for the reabsorption of water and digestive solvents from waste products prior to defecation.
Answer: False
The large intestine, not the small intestine, is primarily responsible for reabsorbing water and other digestive solvents from waste products before defecation to maintain proper hydration.
The cecal appendix, when anatomically present, appears to confer a degree of protection against diarrheal episodes in young primates.
Answer: True
The cecal appendix, when present, appears to offer some protection against diarrhea to young primates, suggesting a potential role in gut health.
Identify a common etiological agent responsible for secretory diarrhea.
Answer: Cholera toxin
A common cause of secretory diarrhea is the cholera toxin, which stimulates the secretion of anions, particularly chloride ions, leading to fluid movement into the gastrointestinal tract.
Which of the following factors can precipitate osmotic diarrhea?
Answer: High intakes of undigested lactose or excess fructose
Osmotic diarrhea can be caused by high intakes of undigested lactose (in lactose intolerance) or excess fructose, as these unabsorbed substances draw water into the bowels.
Exudative diarrhea, marked by the presence of blood and pus in the stool, is characteristically associated with which clinical conditions?
Answer: Inflammatory bowel diseases and severe infections like *E. coli*
Exudative diarrhea is typically associated with inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis, and severe infections like those caused by *E. coli*.
Describe the fundamental physiological impairment that underlies the manifestation of diarrhea.
Answer: The large intestine's inability to sufficiently reabsorb water and other digestive fluids.
Diarrhea occurs when the large intestine is unable to sufficiently reabsorb water and other digestive fluids from fecal matter, a process normally crucial for maintaining hydration.
Identify which of the following conditions represents a specific etiology of malabsorption-induced diarrhea.
Answer: Pernicious anemia
Pernicious anemia is a specific cause of malabsorption due to the inability to absorb vitamin B12, which can lead to diarrhea. Hyperthyroidism, IBS, and chronic ethanol ingestion can cause diarrhea but are not primarily malabsorptive causes in the same way.
Based on the hypothesis by Nesse and Williams, what potential evolutionary function might diarrhea serve?
Answer: As an evolved expulsion defense mechanism.
Researchers Nesse and Williams proposed that diarrhea might function as an evolved expulsion defense mechanism, suggesting it could play a protective role in pathogen clearance.
Within the human gastrointestinal tract, which organ bears primary responsibility for the reabsorption of water and other digestive solvents from waste products prior to defecation?
Answer: Large intestine
The large intestine is primarily responsible for reabsorbing water and other digestive solvents from waste products before defecation to maintain proper hydration and overall bodily equilibrium.
Identify which of the following ion transporters plays a role in the *secretory* processes characteristic of infectious diarrhea.
Answer: CFTR
In the pathophysiology of infectious diarrhea, CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) is an ion transporter involved in the secretion process, along with CaCC and NKCC1.
The most prevalent etiology of diarrhea is an intestinal infection, which may be caused by viral, bacterial, or parasitic agents.
Answer: True
Infectious gastroenteritis, caused by viruses, bacteria, or parasites, is recognized as the most common cause of diarrhea.
Diarrhea is exclusively caused by infectious agents and cannot be attributed to non-infectious factors.
Answer: False
Diarrhea can be caused by numerous non-infectious factors, including conditions such as lactose intolerance, irritable bowel syndrome, celiac disease, and certain medications, in addition to infectious agents.
In pediatric populations under five years of age, acute diarrhea is predominantly caused by bacterial infections.
Answer: False
In young children under five, acute diarrhea is most commonly caused by viral gastroenteritis, with rotavirus accounting for a significant percentage of cases.
Chronic diarrhea may manifest as a symptom of underlying conditions such as ulcerative colitis, Crohn's disease, and celiac disease.
Answer: True
Chronic diarrhea is a known symptom of several chronic medical conditions affecting the intestine, including ulcerative colitis, Crohn's disease, and celiac disease.
*Clostridioides difficile* is a frequent cause of severe diarrhea, especially in elderly patients with a recent history of antibiotic therapy.
Answer: True
*Clostridioides difficile* is a bacterium known to cause severe diarrhea, particularly in elderly individuals who have recently been treated with antibiotics, due to its toxin production.
Protozoan parasites, including *Cryptosporidium* spp. and *Giardia* spp., are commonly implicated in chronic infectious diarrhea.
Answer: True
Protozoan parasites such as *Cryptosporidium* spp. and *Giardia* spp. are frequently identified as causes of chronic infectious diarrhea.
Zinc deficiency can predispose children to increased severity and frequency of diarrheal episodes.
Answer: True
Zinc deficiency, common in children in developing countries, can significantly impair the immune system, leading to increased severity, frequency, and fever-associated diarrheal episodes.
Ulcerative colitis characteristically presents with well-demarcated segments of bowel involvement, frequently affecting the terminal ileum.
Answer: False
Ulcerative colitis is characterized by chronic bloody diarrhea and inflammation primarily affecting the distal colon near the rectum. Crohn's disease, not ulcerative colitis, typically involves well-demarcated segments of the bowel and often impacts the end of the small bowel.
Identify the most prevalent etiology of diarrhea.
Answer: An infection of the intestines (gastroenteritis)
The most common cause of diarrhea is an infection of the intestines, often referred to as gastroenteritis, which can be caused by a virus, bacterium, or parasite.
Identify a non-infectious factor among the following that can induce diarrhea.
Answer: Celiac disease
Celiac disease is a non-infectious factor that can cause diarrhea due to malabsorption. Rotavirus, cholera toxin, and *Campylobacter* spp. are infectious causes.
Identify the most prevalent etiology of acute diarrhea in individuals undertaking international travel.
Answer: Bacterial infections
In travelers, bacterial infections are the predominant cause of acute diarrhea.
Which of the following bacterial pathogens is a common cause of infectious diarrhea, specifically recognized as a leading etiology of infectious bloody diarrhea in the United States?
Answer: Shiga-toxin producing *E. coli* (O157:H7)
Shiga-toxin producing *E. coli* (O157:H7) is a leading cause of infectious bloody diarrhea in the United States, among other bacterial causes like *Campylobacter* spp., *Salmonella* spp., and *Shigella* spp.
Identify the protozoan parasite frequently implicated in chronic infectious diarrhea.
Answer: *Giardia* spp.
Protozoan parasites such as *Cryptosporidium* spp. and *Giardia* spp. are frequently the cause of diarrhea that involves chronic infection.
Describe the impact of zinc deficiency on the clinical course of diarrheal disease in pediatric patients.
Answer: It significantly impairs the immune system, leading to increased severity and frequency of episodes.
Zinc deficiency significantly impairs the immune system, leading to increased severity, frequency, and fever-associated diarrheal episodes in children.
Describe the characteristic diarrheal presentation of Ulcerative Colitis.
Answer: With chronic bloody diarrhea and inflammation primarily affecting the distal colon near the rectum.
Ulcerative colitis is characterized by chronic bloody diarrhea and inflammation that primarily affects the distal colon near the rectum. Well-demarcated segments impacting the end of the small bowel are characteristic of Crohn's disease.
Initial clinical indicators of dehydration secondary to diarrhea typically include decreased urination and a rapid heart rate.
Answer: False
Initial signs of dehydration from diarrhea primarily involve a loss of normal skin turgor and irritability. Decreased urination and a fast heart rate are indicative of more severe dehydration.
Diarrheal disease exerts no significant long-term sequelae on a child's cognitive development.
Answer: False
Diarrheal disease can have profound negative impacts on mental development, with evidence suggesting lower intelligence test scores in children who have experienced severe diarrhea.
Diarrhea can accelerate gastrointestinal transit, thereby diminishing the therapeutic efficacy of orally administered medications.
Answer: True
Diarrhea can cause oral medications to pass too quickly through the digestive system, limiting their absorption time and thus reducing their therapeutic effect.
Recurrent episodes of diarrhea in young children can result in long-term sequelae, including stunted growth and impaired intellectual development.
Answer: True
Frequent episodes of diarrhea in young children are a common cause of malnutrition and can lead to long-term problems such as stunted growth and poor intellectual development.
Which of the following represents an initial clinical manifestation of dehydration secondary to diarrheal illness?
Answer: Loss of the normal stretchiness of the skin
Initial signs of dehydration often include a loss of the normal stretchiness of the skin and irritable behavior. Decreased urination, loss of skin color, and reduced responsiveness are signs of more severe dehydration.
Identify a significant long-term health sequela of diarrheal disease in pediatric populations.
Answer: Lower scores on intelligence tests
Diarrheal disease can have profound negative impacts on mental development, and evidence suggests that children who have experienced severe diarrhea may have significantly lower scores on intelligence tests.
Analyze the impact of diarrhea on the pharmacokinetic profile and therapeutic efficacy of orally administered medications.
Answer: It causes them to pass too quickly through the digestive system, reducing absorption.
Diarrhea can cause oral medications to pass too quickly through the digestive system, limiting their absorption time and thus reducing their therapeutic effect.
Beyond malnutrition, identify another significant long-term developmental sequela of recurrent diarrheal episodes in young children.
Answer: Stunted growth and poor intellectual development
Frequent episodes of diarrhea, in addition to being a common cause of malnutrition, can also lead to long-term problems such as stunted growth and poor intellectual development in young children.
Poverty exacerbates the incidence of infectious diarrhea through factors such as inadequate access to clean water and proper sanitary waste disposal.
Answer: True
Poverty is a strong indicator of infectious diarrhea rates, as impoverished populations often lack access to clean water and sanitary fecal waste disposal, among other factors that compromise defense against infection.
Global mortality attributed to diarrheal diseases declined from an estimated 4.5 million in 1980 to 1.53 million in 2019.
Answer: True
Global deaths from diarrheal diseases significantly decreased from an estimated 4.5 million in 1980 to 1.53 million in 2019, reflecting a substantial reduction in mortality.
Rotavirus accounts for approximately 40% of diarrheal disease-related hospitalizations in children under five years of age.
Answer: True
Rotavirus is a significant cause of childhood diarrhea, responsible for nearly 40% of hospitalizations from diarrhea in children under five years old.
The global annual incidence of diarrhea is estimated to be between 1.7 and 5 billion cases.
Answer: True
Approximately 1.7 to 5 billion cases of diarrhea are estimated to occur globally each year.
In developing countries, young children typically experience diarrheal episodes on average once per year.
Answer: False
In developing countries, young children experience diarrhea on average three times a year, not once a year.
In 2012, diarrheal disease ranked as the second leading cause of mortality among children under five years of age.
Answer: True
In 2012, diarrheal disease was indeed the second most common cause of deaths in children younger than five, accounting for 0.76 million deaths.
Explain the mechanism by which poverty contributes to the heightened prevalence of infectious diarrhea.
Answer: By limiting access to clean water and sanitary fecal waste disposal.
Poverty contributes to higher rates of infectious diarrhea by limiting access to clean water and sanitary fecal waste disposal, among other factors that compromise defense against infection.
In 2012, what was the global ranking of diarrheal disease as a leading cause of mortality among children under five years of age?
Answer: Second
In 2012, diarrheal disease was the second most common cause of deaths in children younger than five, accounting for 0.76 million deaths or 11% of mortalities in this age group.
What proportion of diarrheal disease-related hospitalizations in children under five years of age is attributable to Rotavirus?
Answer: Nearly 40%
Rotavirus is responsible for nearly 40% of hospitalizations from diarrhea in children under five years old.
What is the estimated global annual incidence of diarrheal disease?
Answer: 1.7 to 5 billion cases
Approximately 1.7 to 5 billion cases of diarrhea occur globally each year.
In developing countries, what is the average annual frequency of diarrheal episodes experienced by young children?
Answer: Three times a year
In developing countries, young children experience diarrhea on average three times a year.
Irritable bowel syndrome (IBS) with predominant diarrhea is diagnosed based on abdominal discomfort alleviated by defecation, coupled with altered stool patterns occurring for a minimum of three days per week over the preceding three months.
Answer: True
The diagnostic criteria for Irritable Bowel Syndrome (IBS) with predominant diarrhea include abdominal discomfort relieved by defecation, along with unusual stool patterns occurring for at least three days a week over the preceding three months.
Medical investigation for diarrhea is generally not indicated in the presence of bloody stools.
Answer: False
Further medical investigation for diarrhea is strongly recommended when diarrhea is associated with blood in the stool, as this indicates a more serious underlying condition.
In cases of diarrhea persisting beyond four weeks, a hydrogen breath test is a primary recommendation for diagnosing celiac disease.
Answer: False
For diarrhea lasting longer than four weeks, tissue transglutaminase testing is recommended for celiac disease, while a hydrogen breath test is used for lactose intolerance or small intestinal bacterial overgrowth.
Under what circumstances is further medical investigation for diarrhea specifically recommended?
Answer: In cases of moderate or severe diarrhea in young children.
Further medical investigation for diarrhea is recommended in cases of moderate or severe diarrhea in young children, when diarrhea is associated with blood, or if it continues for more than two days, among other indicators.
Enhancements in drinking water quality and sanitation, collectively termed WASH interventions, have been demonstrated to elevate the risk of diarrheal disease.
Answer: False
Improvements in drinking water quality and sanitation (WASH interventions) have been consistently shown to reduce the risk of diarrhea, not increase it.
Consistent hand washing with soap and water is capable of reducing the incidence of diarrheal disease by an estimated 30% to 48%.
Answer: True
Experimental studies have shown that consistent hand washing with soap and water can reduce the incidence of diarrheal disease by approximately 30% to 48%.
The World Health Organization advocates for exclusive breastfeeding for the initial year of an infant's life as a primary measure for diarrheal disease prevention.
Answer: False
The World Health Organization recommends exclusive breastfeeding for the first six months of an infant's life, with continued breastfeeding until at least two years of age, not exclusively for the first year.
Enhanced water sanitation and hygiene interventions are projected to decrease child mortality from diarrheal disease by an estimated 88%.
Answer: True
It has been proposed that improved water sanitation and hygiene could lead to an estimated 88% reduction in child mortality resulting from diarrheal disease.
Quantify the estimated reduction in child mortality from diarrheal disease achievable through comprehensive improvements in water sanitation and hygiene.
Answer: 88%
It has been proposed that improved water sanitation and hygiene could lead to an estimated 88% reduction in child mortality resulting from diarrheal disease.
State the World Health Organization's recommendation concerning breastfeeding practices for the prevention of diarrheal disease.
Answer: Exclusive breastfeeding for the first six months, with continued breastfeeding until at least two years of age.
The World Health Organization recommends exclusive breastfeeding for the first six months of an infant's life, with continued breastfeeding until at least two years of age, to dramatically protect infants against diarrheal diseases.
The primary therapeutic approach for diarrhea entails the replenishment of lost fluids and electrolytes, commonly achieved via oral rehydration therapy.
Answer: True
The primary treatment for diarrhea involves replacing lost fluid and salts, usually done orally through oral rehydration therapy (ORS).
The BRAT diet (bananas, rice, applesauce, toast) is strongly advocated for pediatric patients experiencing diarrhea.
Answer: False
Diet restrictions, such as the BRAT diet, are no longer recommended for children with diarrhea, as research indicates they have no effect on the duration of the illness.
Beverages with high concentrations of simple sugars are recommended for young children with diarrhea to supply essential energy.
Answer: False
Drinks high in simple sugars are not recommended for young children with diarrhea because they can increase dehydration by drawing water from the body into the gut.
The World Health Organization advises withholding food from a child with diarrhea to facilitate gastrointestinal rest.
Answer: False
The World Health Organization strongly recommends that a child with diarrhea continue to be fed, never withholding food and not diluting usual foods, to support recovery and growth.
Antidiarrheal agents are categorized into four primary groups based on their mechanisms of action: antimotility, antisecretory, adsorbent, and anti-infectious agents.
Answer: True
Antidiarrheal agents are indeed classified into four main groups: antimotility, antisecretory, adsorbent, and anti-infectious agents, based on their distinct mechanisms of action.
Antibiotics are routinely prescribed for all instances of diarrhea to mitigate bacterial dissemination.
Answer: False
Antibiotics are rarely used for diarrhea and are only recommended in specific situations, such as bloody diarrhea with high fever or confirmed bacterial/parasitic infections, due to concerns about resistance and side effects.
A 2020 Cochrane Review determined that probiotics substantially shorten the duration of acute infectious diarrhea.
Answer: False
A 2020 Cochrane Review concluded that probiotics offer little to no difference for individuals experiencing diarrhea lasting two days or longer, and there is no conclusive proof that they reduce the duration of the illness.
The probiotic *Lactobacillus* has demonstrated efficacy in preventing antibiotic-associated diarrhea in adult populations.
Answer: True
The probiotic *Lactobacillus* has been shown to help prevent antibiotic-associated diarrhea in adults, although its effectiveness in children for this specific purpose is less certain.
The administration of digestive enzymes containing lactase can ameliorate symptoms in individuals with lactose intolerance who ingest dairy products.
Answer: True
For individuals with lactose intolerance, taking digestive enzymes that contain lactase when consuming dairy products can often improve symptoms by breaking down lactose, which otherwise might cause osmotic diarrhea.
Should a child experience emesis during ORS treatment, the solution must be immediately discontinued, and urgent medical attention pursued.
Answer: False
If a child vomits during the first hour or two of ORS treatment, it is recommended to wait five or ten minutes and then restart giving the solution more slowly, as most of the fluid is usually still absorbed.
Identify the primary therapeutic intervention for diarrhea.
Answer: Replacing lost fluid and salts, usually through oral rehydration therapy.
The primary treatment for diarrhea involves replacing lost fluid and salts, which is usually done orally through oral rehydration therapy (ORS).
Provide the physiological rationale for avoiding high-sugar beverages in young children afflicted with diarrhea.
Answer: They can increase dehydration by drawing water from the body into the gut.
Drinks high in simple sugars are not recommended for children under five with diarrhea because their high sugar concentration in the gut can draw water from the body, thereby increasing dehydration.
Articulate the World Health Organization's guidance on nutritional management for children experiencing diarrhea.
Answer: Continue to feed the child, never withholding food and not diluting usual foods.
The World Health Organization strongly recommends that a child with diarrhea continue to be fed, emphasizing that food should never be withheld and the child's usual foods should not be diluted, to support recovery and growth.
Which of the following is NOT recognized as a primary classification of antidiarrheal pharmacological agents?
Answer: Antihistamine agents
Antidiarrheal agents are classified into antimotility, antisecretory, adsorbent, and anti-infectious agents. Antihistamine agents are not a classification of antidiarrheal agents.
Under what specific clinical circumstances might antibiotic therapy be indicated for diarrheal disease?
Answer: In cases of bloody diarrhea accompanied by a high fever.
Antibiotics are rarely used for diarrhea but may be recommended in specific situations, such as cases of bloody diarrhea accompanied by a high fever, severe diarrhea following travel, or when specific bacteria or parasites are identified.
According to a 2020 Cochrane Review, what was the conclusion regarding the efficacy of probiotics in the management of acute infectious diarrhea?
Answer: Probiotics offer little to no difference for individuals experiencing diarrhea lasting two days or longer.
A Cochrane Review from 2020 concluded that probiotics offer little to no difference for individuals experiencing diarrhea lasting two days or longer, and there is no conclusive proof that they reduce the duration of the illness.
Explain the mechanism by which exogenous digestive enzymes can alleviate diarrhea in individuals with lactose intolerance.
Answer: By breaking down the milk sugar lactose, which otherwise might cause osmotic diarrhea.
For individuals with lactose intolerance, taking digestive enzymes that contain lactase helps break down the milk sugar lactose, preventing its accumulation and subsequent osmotic diarrhea.
What is the appropriate clinical management strategy if a child experiences emesis during the initial one to two hours of Oral Rehydration Solution (ORS) administration?
Answer: Wait five or ten minutes and then restart giving the solution more slowly.
If a child vomits during the first hour or two of ORS treatment, it is recommended to wait five or ten minutes and then restart giving the solution more slowly, as most of the fluid is usually still absorbed despite the vomiting.
Bile acid sequestrants, such as cholestyramine, are efficacious in managing chronic diarrhea stemming from which specific condition?
Answer: Bile acid malabsorption
Bile acid sequestrants, such as cholestyramine, are effective in treating chronic diarrhea caused by bile acid malabsorption.