Chronic diarrhea classification: Difference between revisions
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==Overview== | ==Overview== | ||
Chronic diarrhea may be classified into 3 basic categories: watery, fatty(malabsorption) and inflammatory (with blood and pus). It is important to note that not all chronic diarrhea falls into one category alone. The differential diagnosis for chronic diarrhea is enormous, with a large number of diagnostic tests available that can be used to evaluate these patients. Classifying the patient with chronic diarrhea into a subcategory helps to direct the diagnostic work-up. | Chronic diarrhea may be classified into 3 basic categories: [[Watery diarrhea|watery]], [[Steatorrhea|fatty]]([[malabsorption]]) and [[inflammatory]] (with blood and pus). It is important to note that not all chronic diarrhea falls into one category alone. The differential diagnosis for chronic diarrhea is enormous, with a large number of diagnostic tests available that can be used to evaluate these patients. Classifying the patient with chronic diarrhea into a subcategory helps to direct the diagnostic work-up. | ||
==Classification== | ==Classification== | ||
Chronic diarrhea may be classified into <ref name="FineSchiller1999">{{cite journal|last1=Fine|first1=K|last2=Schiller|first2=L|title=AGA Technical Review on the Evaluation and Management of Chronic Diarrhea☆|journal=Gastroenterology|volume=116|issue=6|year=1999|pages=1464–1486|issn=00165085|doi=10.1016/S0016-5085(99)70513-5}}</ref><ref>{{cite journal|title=American Gastroenterological Association medical position statement: Guidelines for the evaluation and management of chronic diarrhea☆, ☆☆|journal=Gastroenterology|volume=116|issue=6|year=1999|pages=1461–1463|issn=00165085|doi=10.1016/S0016-5085(99)70512-3}}</ref><ref name="pmid15017602">{{cite journal| author=Camilleri M| title=Chronic diarrhea: a review on pathophysiology and management for the clinical gastroenterologist. | journal=Clin Gastroenterol Hepatol | year= 2004 | volume= 2 | issue= 3 | pages= 198-206 | pmid=15017602 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15017602 }} </ref><ref name="pmid10699778">{{cite journal| author=Fine KD, Seidel RH, Do K| title=The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea. | journal=Gastrointest Endosc | year= 2000 | volume= 51 | issue= 3 | pages= 318-26 | pmid=10699778 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10699778 }} </ref> | Chronic diarrhea may be classified into <ref name="FineSchiller1999">{{cite journal|last1=Fine|first1=K|last2=Schiller|first2=L|title=AGA Technical Review on the Evaluation and Management of Chronic Diarrhea☆|journal=Gastroenterology|volume=116|issue=6|year=1999|pages=1464–1486|issn=00165085|doi=10.1016/S0016-5085(99)70513-5}}</ref><ref>{{cite journal|title=American Gastroenterological Association medical position statement: Guidelines for the evaluation and management of chronic diarrhea☆, ☆☆|journal=Gastroenterology|volume=116|issue=6|year=1999|pages=1461–1463|issn=00165085|doi=10.1016/S0016-5085(99)70512-3}}</ref><ref name="pmid15017602">{{cite journal| author=Camilleri M| title=Chronic diarrhea: a review on pathophysiology and management for the clinical gastroenterologist. | journal=Clin Gastroenterol Hepatol | year= 2004 | volume= 2 | issue= 3 | pages= 198-206 | pmid=15017602 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15017602 }} </ref><ref name="pmid10699778">{{cite journal| author=Fine KD, Seidel RH, Do K| title=The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea. | journal=Gastrointest Endosc | year= 2000 | volume= 51 | issue= 3 | pages= 318-26 | pmid=10699778 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10699778 }} </ref> | ||
*Inflammatory diarrhea | *[[Inflammatory|Inflammatory diarrhea]] | ||
*Watery diarrhea | *[[Watery diarrhea]] | ||
*Fatty diarrhea | *[[Steatorrhea|Fatty diarrhea]] | ||
===Inflammatory diarrhea=== | ===Inflammatory diarrhea=== | ||
Diarrhea is said to be due to an inflammatory cause when stool analysis such as stool cultures, flexible sigmoidoscopy or colonoscopy with biopsies show evidence of the presence of fecal leukocytes. Causes of inflammatory diarrhea include; | Diarrhea is said to be due to an [[inflammatory]] cause when stool analysis such as stool cultures, [[flexible sigmoidoscopy]] or [[colonoscopy]] with biopsies show evidence of the presence of fecal leukocytes. Causes of inflammatory diarrhea include; | ||
*Idiopathic inflammatory bowel disease such as Crohn’s disease or ulcerative colitis | *Idiopathic [[inflammatory bowel disease]] such as [[Crohn’s disease]] or [[ulcerative colitis]] | ||
*Infectious diseases such as cytomegalovirus, herpes simplex, tuberculosis, strongyloidiasis, Aeromonas or Plesiomonas | *Infectious diseases such as [[cytomegalovirus]], [[herpes simplex]], [[tuberculosis]], [[strongyloidiasis]], [[Aeromonas]] or [[Plesiomonas shigelloides|Plesiomonas]] | ||
*Ischemic colitis, | *[[Ischemic colitis]], | ||
*Radiation colitis, and | *[[Radiation colitis]], and | ||
*Neoplasia. | *[[Neoplasia]]. | ||
===Watery diarhea=== | ===Watery diarhea=== | ||
Watery diarrhea can be classified as; | Watery diarrhea can be classified as; | ||
*Osmotic diarrhea: this is the more common type however it has a limited differential diagnosis which includes; | *Osmotic diarrhea: this is the more common type however it has a limited differential diagnosis which includes; | ||
**Ingestion of exogenous magnesium, | **Ingestion of exogenous [[magnesium]], | ||
**Carbohydrate malabsorption, or | **Carbohydrate [[malabsorption]], or | ||
**consumption of poorly absorbable carbohydrates. | **consumption of poorly absorbable carbohydrates. | ||
*Secretory diarrhea : This is the less common type, the differential diagnosis of secretory diarrhea is quite vast. However, the incidence of these diseases is low. Some of the differentials include but are not limited to; | *Secretory diarrhea : This is the less common type, the differential diagnosis of secretory diarrhea is quite vast. However, the incidence of these diseases is low. Some of the differentials include but are not limited to; | ||
**Aeromonas | **[[Aeromonas]] | ||
**Plesiomonas | **[[Plesiomonas shigelloides|Plesiomonas]] | ||
**Microsporidia | **[[Microsporidia]] | ||
**Giardia | **[[Giardia]] | ||
**Coccidia | **[[Coccidia]] | ||
**Cryptosporidium, | **[[Cryptosporidium]], | ||
Structural and Endocrine diseases should also be considered, | |||
**Diabetes | * Structural and Endocrine diseases should also be considered, such as; | ||
**Hyperthyroidism | ** [[Diabetes]] | ||
** | ** [[Hyperthyroidism]] | ||
**Peptide | ** [[Addison's disease]] | ||
** Peptide secreting [[endocrine tumors]] | |||
* | |||
===Fatty diarrhea=== | ===Fatty diarrhea=== | ||
Fatty diarrhea can be described either due to malabsorption or maldigestion problems; | Fatty diarrhea can be described either due to [[malabsorption]] or [[maldigestion]] problems; | ||
*Malabsorption; 3 most common causes of malabsorption are | *[[Malabsorption]]; 3 most common causes of [[malabsorption]] are | ||
**Celiac sprue | **[[Celiac sprue]] | ||
**Pancreatic insufficiency | **[[Pancreatic insufficiency]] | ||
**Bacterial overgrowth | **[[Bacterial overgrowth]] | ||
*Maldigestion; Maldigestion results from pancreatic exocrine insufficiency | *Maldigestion; Maldigestion results from pancreatic exocrine insufficiency | ||
Revision as of 15:54, 21 June 2017
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Chronic diarrhea Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
Chronic diarrhea may be classified into 3 basic categories: watery, fatty(malabsorption) and inflammatory (with blood and pus). It is important to note that not all chronic diarrhea falls into one category alone. The differential diagnosis for chronic diarrhea is enormous, with a large number of diagnostic tests available that can be used to evaluate these patients. Classifying the patient with chronic diarrhea into a subcategory helps to direct the diagnostic work-up.
Classification
Chronic diarrhea may be classified into [1][2][3][4]
Inflammatory diarrhea
Diarrhea is said to be due to an inflammatory cause when stool analysis such as stool cultures, flexible sigmoidoscopy or colonoscopy with biopsies show evidence of the presence of fecal leukocytes. Causes of inflammatory diarrhea include;
- Idiopathic inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
- Infectious diseases such as cytomegalovirus, herpes simplex, tuberculosis, strongyloidiasis, Aeromonas or Plesiomonas
- Ischemic colitis,
- Radiation colitis, and
- Neoplasia.
Watery diarhea
Watery diarrhea can be classified as;
- Osmotic diarrhea: this is the more common type however it has a limited differential diagnosis which includes;
- Ingestion of exogenous magnesium,
- Carbohydrate malabsorption, or
- consumption of poorly absorbable carbohydrates.
- Secretory diarrhea : This is the less common type, the differential diagnosis of secretory diarrhea is quite vast. However, the incidence of these diseases is low. Some of the differentials include but are not limited to;
- Structural and Endocrine diseases should also be considered, such as;
- Diabetes
- Hyperthyroidism
- Addison's disease
- Peptide secreting endocrine tumors
Fatty diarrhea
Fatty diarrhea can be described either due to malabsorption or maldigestion problems;
- Malabsorption; 3 most common causes of malabsorption are
- Maldigestion; Maldigestion results from pancreatic exocrine insufficiency
References
- ↑ Fine, K; Schiller, L (1999). "AGA Technical Review on the Evaluation and Management of Chronic Diarrhea☆". Gastroenterology. 116 (6): 1464–1486. doi:10.1016/S0016-5085(99)70513-5. ISSN 0016-5085.
- ↑ "American Gastroenterological Association medical position statement: Guidelines for the evaluation and management of chronic diarrhea☆, ☆☆". Gastroenterology. 116 (6): 1461–1463. 1999. doi:10.1016/S0016-5085(99)70512-3. ISSN 0016-5085.
- ↑ Camilleri M (2004). "Chronic diarrhea: a review on pathophysiology and management for the clinical gastroenterologist". Clin Gastroenterol Hepatol. 2 (3): 198–206. PMID 15017602.
- ↑ Fine KD, Seidel RH, Do K (2000). "The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea". Gastrointest Endosc. 51 (3): 318–26. PMID 10699778.