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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==
==Causes==
Some common causes of chronic diarrhea and their clinical findings include;<ref name="pmid10348832">{{cite journal| author=Fine KD, Schiller LR| title=AGA technical review on the evaluation and management of chronic diarrhea. | journal=Gastroenterology | year= 1999 | volume= 116 | issue= 6 | pages= 1464-86 | pmid=10348832 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10348832  }} </ref>
===Life threatening causes===
 
There are no life-threatening causes of chronic [[diarrhea]]; however, complications resulting from untreated chronic [[diarrhea]] are common.
*'''Celiac disease''': Patients present with chronic malabsorptive diarrhea, fatigue, iron deficiency anemia, weight loss, dermatitis herpetiformis, and a positive family history of celiac disease. Tests that can be done include immunoglobulin A, antiendomysium and antitissue transglutaminase antibodies, the most accurate being duodenal biopsy.
 
*'''Clostridium difficile infection''': Patients often presents with an inflammatory diarrhea with weight loss, recent history of antibiotic use, evidence of colitis and fever which may not resolve with discontinuation of antibiotics. Some tests that can be useful in the diagnosis include fecal leukocyte level, enzyme immunoassay that detects toxins A and B, positive fecal toxin assay and  sigmoidoscopy demonstrating pseudomembranes.


*'''Drug-induced diarrhea''': If diarrhea is osmotic consider magnesium, phosphates, sulfates, and sorbitol. If hypermotility consider stimulant laxatives or malabsorption acarbose, orlistat. Elimination of offending agent is often curative.  
===Common causes===
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> 
*'''[[Celiac disease|Malabsorption]]'''
**[[Cystic fibrosis]]
**[[celiac disease|Celiac disease]]
**[[Disaccharidase|Disaccharidase deficiency]]
*'''[[Irritable bowel syndrome]]'''
*[[Inflammatory bowel disease|'''Inflammatory bowel disease''']]
**[[Crohn's disease|Crohn disease]]
**[[ulcerative colitis|Ulcerative colitis]]
* '''[[Microscopic colitis]]'''
*'''Anatomic abnormalities'''
**[[Intussusception]]
**[[Hirschsprung's disease]] (with and without toxic [[megacolon]])
**[[Partial bowel obstructions|Partial bowel obstruction]]
**[[Blind loop syndrome]] (also in patients with dysmotility)
**Intestinal lymphangiectasis
**[[Short gut syndrome]]


*'''Endocrine diarrhea''': Secretory diarrhea e,g Addison disease, carcinoid tumors, vipoma, gastrinoma (Zollinger-Ellison syndrome), and mastocytosis  or increased motility (hyperthyroidism). Tests that can be ordered included thyroid-stimulating hormone level, serum peptide concentrations, urinary histamine level.
*[[Immunodeficiency|'''Immunodeficiency''']]
**[[Severe combined immunodeficiency disorder]] and other genetic disorders
**[[HIV]]


*'''Giardiasis''': Patients presents with excess gas, steatorrhea (malabsorption). Giardia fecal antigen test is diagnostic.
*'''Endocrine diarrhea'''  
**[[Addison's disease]]
**[[Carcinoid tumors]]
**[[VIPoma|Vipoma]]
**[[Gastrinoma]] ([[Zollinger-Ellison syndrome]])  
**[[Mastocytosis]]  or increased motility
**[[Hyperthyroidism]]


*'''Infectious enteritis or colitis (diarrhea not associated with C. difficile)''': Examples include bacterial gastroenteritis, viral gastroenteritis, amebic dysentery. Patients present with inflammatory diarrhea, nausea, vomiting, fever, abdominal pain. History of travel, camping, infectious contacts, or day care attendance. Fecal leukocyte level, elevated erythrocyte sedimentation rate
*'''Infectious enteritis or colitis (diarrhea not associated with ''C. difficile'')'''  
Cultures or stained fecal smears for specific organisms are more definitive.
**[[Bacterial gastroenteritis]]
**[[Viral gastroenteritis]]
**[[Amebic dysentery]]


*'''Inflammatory bowel disease''': Crohn disease, ulcerative colitis, patients present with bloody inflammatory diarrhea, abdominal pain, nausea, vomiting, loss of appetite, family history, eye findings (e.g., episcleritis), perianal fistulae, fever, tenesmus, rectal bleeding, weight loss. Tests include complete blood count, fecal leukocyte level, erythrocyte sedimentation rate, fecal calprotectin level. Characteristic intestinal ulcerations are seen on colonoscopy.
*'''[[Ischemic colitis]]'''


*'''Irritable bowel syndrome''': Patients present with sool mucus, crampy abdominal pain, altered bowel habits, watery functional diarrhea after meals, exacerbated by emotional stress or eating. It is twice as common in women than men. All laboratory test results are normal. Increased fiber intake, exercise, dietary modification should be recommended.
*'''Miscellaneous'''  
**Antibiotic-associated diarrhea  
**[[Pseudomembranous colitis]]
**[[Hemolytic-uremic syndrome|Hemolytic uremic syndrome]]
**[[Neonatal drug withdrawal]]


*'''Ischemic colitis''':History of vascular disease and pain associated with eating. Colonoscopy and  abdominal arteriography is diagnostic.
===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'''
*'''Microscopic colitis''': Patients present with watery, secretory diarrhea affecting older persons. Nonsteroidal anti-inflammatory drug association is  possible. There is usually no response to fasting; nocturnal symptoms present. Colon biopsy is recommended.
**[[Magnesium]] containing antacids
 
**[[Laxatives]]
 
**[[Cisapride]]
===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>===
**[[Olsalazine]]
*Gastrointestinal drugs
*'''Cardiac drugs'''
**Magnesium containing antacids
**[[Digitalis]]
**Laxatives
**[[Quinidine]]
**Cisapride
**[[Procainamide]]
**Olsalazine
**[[Hydralazine]]
*Cardiac drugs
**[[Beta blockers|Beta-blockers]]
**Digitalis
**[[ACE inhibitor|ACE inhibitors]]
**Quinidine
**[[Diuretics]]
**Procainamide
*'''Antibiotics'''
**Hydralazine
**[[Clindamycin]]
**Beta-blockers
**[[Ampicillin]]
**ACE inhibitors
**[[Amoxycillin]]
**Diuretics
**[[Erythromycin]]
*Antibiotics
**[[Cephalosporin|Cephalosporins]]
**Clindamycin
*'''Chemotherapeutic agents'''
**Ampicillin
*'''Hypolipidemic agents'''
**Amoxycillin
**[[Clofibrate]]
**Erythromycin
**[[Gemfibrozil]]
**Cephalosporins
**[[Lovastatin]]
*Chemotherapeutic agents
*'''Neuropsychiatric drugs'''
*Hypolipidemic agents
**[[Lithium]]
**Clofibrate
**[[Fluoxetine]]
**Gemfibrozil
**[[Alprazolam]]
**Lovastatin
*'''Others'''
*Neuropsychiatric drugs
**[[Aminophylline]]
**Lithium
**[[Salbutamol]]
**Fluoxetine
**[[Non-steroidal anti-inflammatory drug|Non-steroidal anti-inflammatory drugs]]
**Alprazolam
**[[Thyroid hormones]]
*Others
**[[Colchicine]]
**Aminophylline
**Salbutamol
**Non-steroidal anti-inflammatory drugs
**Thyroid hormones
**Colchicine


==References==
==References==
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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

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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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