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==Overview==
==Overview==
Depending on the socio economic status of the population, chronic diarrhea can be caused by several factors. In a developing nation, the most likely causes of chronic bacteria include; mycobacterial and parasitic infections and less likely to include functional disorders such as malabsorption and inflammatory bowel diseases. In a developed nation however, the most likely cause of diarrhea include; irritable bowel syndrome (IBS), inflammatory bowel disease, malabsorption syndromes (such as lactose intolerance and celiac disease), and chronic infections (particularly in patients who are immunocompromised).
Depending on the socioeconomic status of the [[population]], chronic [[diarrhea]] can be caused by several factors. In a developing nation, the most likely causes of chronic [[diarrhea]] are [[Mycobacterial infection|mycobacterial]] and [[parasitic infections]], while functional disorders such as [[malabsorption]] and [[Inflammatory bowel disease|inflammatory bowel diseases]] are less likely causes. In a developed nation, however, the most likely causes of [[diarrhea]] are [[irritable bowel syndrome]] (IBS), [[inflammatory bowel disease]], [[malabsorption]] syndromes (such as [[lactose intolerance]] and [[celiac disease]]), and chronic [[infections]] (particularly in patients who are [[immunocompromised]]).
==Causes==
===Life threatening causes===
There are no life-threatening causes of chronic [[diarrhea]]; however, complications resulting from untreated chronic [[diarrhea]] are common.


==Causes==
===Common causes===
'''Watery diarrhea'''
There following are some of the common causes of chronic [[diarrhea]]:<ref name="pmid20417725">{{cite journal| author=Jamma S, Rubio-Tapia A, Kelly CP, Murray J, Najarian R, Sheth S et al.| title=Celiac crisis is a rare but serious complication of celiac disease in adults. | journal=Clin Gastroenterol Hepatol | year= 2010 | volume= 8 | issue= 7 | pages= 587-90 | pmid=20417725 | doi=10.1016/j.cgh.2010.04.009 | pmc=2900539 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20417725  }} </ref><ref name="pmid698649">{{cite journal| author=Manning AP, Thompson WG, Heaton KW, Morris AF| title=Towards positive diagnosis of the irritable bowel. | journal=Br Med J | year= 1978 | volume= 2 | issue= 6138 | pages= 653-4 | pmid=698649 | doi= | pmc=1607467 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=698649  }} </ref><ref name="pmid381094">{{cite journal| author=Mekhjian HS, Switz DM, Melnyk CS, Rankin GB, Brooks RK| title=Clinical features and natural history of Crohn's disease. | journal=Gastroenterology | year= 1979 | volume= 77 | issue= 4 Pt 2 | pages= 898-906 | pmid=381094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=381094  }} </ref><ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }} </ref><ref name="pmid7615277">{{cite journal| author=Veress B, Löfberg R, Bergman L| title=Microscopic colitis syndrome. | journal=Gut | year= 1995 | volume= 36 | issue= 6 | pages= 880-6 | pmid=7615277 | doi= | pmc=1382626 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7615277  }} </ref> 
*Osmotic diarrhea
*'''[[Celiac disease|Malabsorption]]'''
**Mg2+, PO43-, SO42- ingestion
**[[Cystic fibrosis]]
**Carbohydrate malabsorption
**[[celiac disease|Celiac disease]]
*Secretory diarrhea
**[[Disaccharidase|Disaccharidase deficiency]]
**Laxative abuse (nonosmotic laxatives)
*'''[[Irritable bowel syndrome]]'''
**Congenital syndromes
*[[Inflammatory bowel disease|'''Inflammatory bowel disease''']]
**Bacterial toxins
**[[Crohn's disease|Crohn disease]]
**Ileal bile acid malabsorption
**[[ulcerative colitis|Ulcerative colitis]]
**Inflammatory bowel disease
* '''[[Microscopic colitis]]'''
***Ulcerative colitis
*'''Anatomic abnormalities'''
***Crohn’s disease
**[[Intussusception]]
***Microscopic (lymphocytic and collagenous) colitis
**[[Hirschsprung's disease]] (with and without toxic [[megacolon]])
***Diverticulitis
**[[Partial bowel obstructions|Partial bowel obstruction]]
**Vasculitis
**[[Blind loop syndrome]] (also in patients with dysmotility)
**Drugs and poisons
**Intestinal lymphangiectasis
**Disordered motility
**[[Short gut syndrome]]
***Postvagotomy diarrhea
 
***Postsympathectomy diarrhea
*[[Immunodeficiency|'''Immunodeficiency''']]
***Diabetic autonomic neuropathy
**[[Severe combined immunodeficiency disorder]] and other genetic disorders
***Hyperthyroidism
**[[HIV]]
***Irritable bowel syndrome
**Neuroendocrine tumors
***Gastrinoma
***VIPoma
***Somatostatinoma
***Mastocytosis
***Carcinoid syndrome
***Medullary carcinoma of thyroid
**Neoplasia
***Colon carcinoma
***Lymphoma
***Villous adenoma
**Addison’s disease
**Epidemic secretory diarrhea
**Idiopathic secretory diarrhea


'''Fatty diarrhea'''
*'''Endocrine diarrhea'''  
*Malabsorption syndromes
**[[Addison's disease]]
**Mucosal diseases
**[[Carcinoid tumors]]
**Short-bowel syndrome
**[[VIPoma|Vipoma]]
**Postresection diarrhea
**[[Gastrinoma]] ([[Zollinger-Ellison syndrome]])
**Mesenteric ischemia
**[[Mastocytosis]]  or increased motility
*Maldigestion
**[[Hyperthyroidism]]
**Pancreatic insufficiency
**Bile acid deficiency


'''Inflammatory diarrhea'''
*'''Infectious enteritis or colitis (diarrhea not associated with ''C. difficile'')'''  
*Inflammatory bowel disease
**[[Bacterial gastroenteritis]]
**Ulcerative colitis
**[[Viral gastroenteritis]]
**Crohn’s disease
**[[Amebic dysentery]]
**Diverticulitis
**Ulcerative jejunoileitis
*Infectious diseases
**Ulcerating viral infections
***Cytomegalovirus
***Herpes simplex
*Ischemic colitis
*Radiation colitis
*Neoplasia
**Colon cancer
**Lymphoma


*'''[[Ischemic colitis]]'''


*'''Miscellaneous'''
**Antibiotic-associated diarrhea
**[[Pseudomembranous colitis]]
**[[Hemolytic-uremic syndrome|Hemolytic uremic syndrome]]
**[[Neonatal drug withdrawal]]


===Drugs that commonly cause diarrhea===
===Drugs that commonly cause diarrhea<ref name="pmid8614603">{{cite journal| author=Branski D, Lerner A, Lebenthal E| title=Chronic diarrhea and malabsorption. | journal=Pediatr Clin North Am | year= 1996 | volume= 43 | issue= 2 | pages= 307-31 | pmid=8614603 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8614603  }} </ref><ref name="pmid28407743">{{cite journal| author=Kroschinsky F, Stölzel F, von Bonin S, Beutel G, Kochanek M, Kiehl M et al.| title=New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management. | journal=Crit Care | year= 2017 | volume= 21 | issue= 1 | pages= 89 | pmid=28407743 | doi=10.1186/s13054-017-1678-1 | pmc=5391608 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28407743  }} </ref><ref name="pmid28027072">{{cite journal| author=Philip NA, Ahmed N, Pitchumoni CS| title=Spectrum of Drug-induced Chronic Diarrhea. | journal=J Clin Gastroenterol | year= 2017 | volume= 51 | issue= 2 | pages= 111-117 | pmid=28027072 | doi=10.1097/MCG.0000000000000752 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28027072  }} </ref>===
*Gastrointestinal drugs
*'''Gastrointestinal drugs'''
**Magnesium containing antacids
**[[Magnesium]] containing antacids
**Laxatives
**[[Laxatives]]
**Cisapride
**[[Cisapride]]
**Olsalazine
**[[Olsalazine]]
*Cardiac drugs
*'''Cardiac drugs'''
**Digitalis
**[[Digitalis]]
**Quinidine
**[[Quinidine]]
**Procainamide
**[[Procainamide]]
**Hydralazine
**[[Hydralazine]]
**Beta-blockers
**[[Beta blockers|Beta-blockers]]
**ACE inhibitors
**[[ACE inhibitor|ACE inhibitors]]
**Diuretics
**[[Diuretics]]
*Antibiotics
*'''Antibiotics'''
**Clindamycin
**[[Clindamycin]]
**Ampicillin
**[[Ampicillin]]
**Amoxycillin
**[[Amoxycillin]]
**Erythromycin
**[[Erythromycin]]
**Cephalosporins
**[[Cephalosporin|Cephalosporins]]
*Chemotherapeutic agents
*'''Chemotherapeutic agents'''
*Hypolipidemic agents
*'''Hypolipidemic agents'''
**Clofibrate
**[[Clofibrate]]
**Gemfibrozil
**[[Gemfibrozil]]
**Lovastatin
**[[Lovastatin]]
*Neuropsychiatric drugs
*'''Neuropsychiatric drugs'''
**Lithium
**[[Lithium]]
**Fluoxetine
**[[Fluoxetine]]
**Alprazolam
**[[Alprazolam]]
*Others
*'''Others'''
*Aminophylline
**[[Aminophylline]]
*Salbutamol
**[[Salbutamol]]
*Non-steroidal anti-inflammatory drugs
**[[Non-steroidal anti-inflammatory drug|Non-steroidal anti-inflammatory drugs]]
*Thyroid hormones
**[[Thyroid hormones]]
*Colchicine
**[[Colchicine]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


{{WH}}
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[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Gastroenterology]]
[[Category:Pediatrics]]

Latest revision as of 20:57, 29 July 2020

Chronic diarrhea Microchapters

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Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Overview

Depending on the socioeconomic status of the population, chronic diarrhea can be caused by several factors. In a developing nation, the most likely causes of chronic diarrhea are mycobacterial and parasitic infections, while functional disorders such as malabsorption and inflammatory bowel diseases are less likely causes. In a developed nation, however, the most likely causes of diarrhea are irritable bowel syndrome (IBS), inflammatory bowel disease, malabsorption syndromes (such as lactose intolerance and celiac disease), and chronic infections (particularly in patients who are immunocompromised).

Causes

Life threatening causes

There are no life-threatening causes of chronic diarrhea; however, complications resulting from untreated chronic diarrhea are common.

Common causes

There following are some of the common causes of chronic diarrhea:[1][2][3][4][5]

Drugs that commonly cause diarrhea[6][7][8]

References

  1. Jamma S, Rubio-Tapia A, Kelly CP, Murray J, Najarian R, Sheth S; et al. (2010). "Celiac crisis is a rare but serious complication of celiac disease in adults". Clin Gastroenterol Hepatol. 8 (7): 587–90. doi:10.1016/j.cgh.2010.04.009. PMC 2900539. PMID 20417725.
  2. Manning AP, Thompson WG, Heaton KW, Morris AF (1978). "Towards positive diagnosis of the irritable bowel". Br Med J. 2 (6138): 653–4. PMC 1607467. PMID 698649.
  3. Mekhjian HS, Switz DM, Melnyk CS, Rankin GB, Brooks RK (1979). "Clinical features and natural history of Crohn's disease". Gastroenterology. 77 (4 Pt 2): 898–906. PMID 381094.
  4. Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
  5. Veress B, Löfberg R, Bergman L (1995). "Microscopic colitis syndrome". Gut. 36 (6): 880–6. PMC 1382626. PMID 7615277.
  6. Branski D, Lerner A, Lebenthal E (1996). "Chronic diarrhea and malabsorption". Pediatr Clin North Am. 43 (2): 307–31. PMID 8614603.
  7. Kroschinsky F, Stölzel F, von Bonin S, Beutel G, Kochanek M, Kiehl M; et al. (2017). "New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management". Crit Care. 21 (1): 89. doi:10.1186/s13054-017-1678-1. PMC 5391608. PMID 28407743.
  8. Philip NA, Ahmed N, Pitchumoni CS (2017). "Spectrum of Drug-induced Chronic Diarrhea". J Clin Gastroenterol. 51 (2): 111–117. doi:10.1097/MCG.0000000000000752. PMID 28027072.

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