Such metabolic changes include alterations in the degradation of nonabsorbed carbohydrates, leading to osmotic diarrhea; decreased bile salt deconjugation by bacteria leading to stimulation of fluid secretion by the colonic mucosa; reduced bacterial degradation of bile salts, which increase intestinal permeability, increase cyclic adenosine monophosphate AMP, activate mast cells, and stimulate colonic chloride secretion see Chapter 101; stimulation of intestinal motility through the motilin- like effect of erythromycin; an allergic reaction; or infection with microorganisms other than C.
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