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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; [[Mycobacterium|mycobacterial]] and [[parasitic infections]] and less likely to include functional disorders such as [[malabsorption]] and [[Inflammatory bowel disease|inflammatory bowel diseases]]. In a developed nation however, the most likely cause of diarrhea include; [[irritable bowel syndrome]] (IBS), [[inflammatory bowel disease]], [[Malabsorption syndrome|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==
===Major causes===
===Life threatening causes===
There are no life-threatening causes of chronic [[diarrhea]]; however, complications resulting from untreated chronic [[diarrhea]] are common.


*'''[[Celiac disease|Malabsorption]]''': Malabsorptive and maldigestive diarrhea result from impaired nutrient absorption and impaired digestive function respectively. Cystic fibrosis, celiac disease, disaccharidase deficiency (eg, lactase deficiency due to infectious diarrhea), can all cause loss of absorptive capacity. Absent pancreatic enzymes or bile acids can cause maldigestion. Classic symptoms include abdominal distention with foul-smelling, large, floating, pale, fatty stools (steatorrhea) and weight loss.
===Common causes===
*'''[[Irritable bowel syndrome]]''': Patients present with stool 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.
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> 
*[[Inflammatory bowel disease|'''Inflammatory bowel disease''':]]May manifest as either  [[Crohn's disease|crohn disease]] or [[ulcerative colitis]], patients present with bloody inflammatory diarrhea, abdominal pain, nausea, vomiting, loss of appetite, family history, eye findings (e.g., [[episcleritis]]), [[Anal fistula|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]].
*'''[[Celiac disease|Malabsorption]]'''
* '''[[Microscopic colitis]]''': Patients present with watery, secretory diarrhea affecting older persons. [[Non-steroidal anti-inflammatory drug|Nonsteroidal anti-inflammatory drug]] association is  possible. There is usually no response to fasting; [[nocturnal]] symptoms present. Colon biopsy is recommended.
**[[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]]


===Minor causes===
*[[Immunodeficiency|'''Immunodeficiency''']]  
*'''Gastrointestinal infections'''; such as [[viruses]], [[bacteria]] and [[parasites]].
**[[Severe combined immunodeficiency disorder]] and other genetic disorders
*'''Non-gastrointestional infections''' (parenteral diarrhea);  systemic infections, staphylococcal toxic shock syndrome, urinary tract infections and other systemic infections.
**[[HIV]]
*'''Anatomic abnormalities'''; Intussusception, hirschsprung disease (± toxic megacolon) partial bowel obstruction, blind loop syndrome (also in patients with dysmotility), Intestinal lymphangiectasis, short gut syndrome.


*[[Immunodeficiency|'''Immunodeficiency''']]; Severe combined immunodeficiencies and other genetic disorders, HIV
*'''Endocrine diarrhea'''  
**[[Addison's disease]]
**[[Carcinoid tumors]]
**[[VIPoma|Vipoma]]
**[[Gastrinoma]] ([[Zollinger-Ellison syndrome]])
**[[Mastocytosis]]  or increased motility
**[[Hyperthyroidism]]  


*'''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.
*'''Infectious enteritis or colitis (diarrhea not associated with ''C. difficile'')'''
**[[Bacterial gastroenteritis]]  
**[[Viral gastroenteritis]]  
**[[Amebic dysentery]]  


*'''Endocrine diarrhea''': Secretory diarrhea e,g [[Addison's disease|Addison disease]], [[carcinoid tumors]], [[VIPoma|vipoma]], [[gastrinoma]] ([[Zollinger-Ellison syndrome]]), and [[mastocytosis]]  or increased motility ([[hyperthyroidism]]). Tests that can be ordered include [[thyroid-stimulating hormone]] level, serum peptide concentrations, urinary [[histamine]] level.
*'''[[Ischemic colitis]]'''


*'''[[Giardiasis]]''': Patients presents with excess gas, [[steatorrhea]] (malabsorption). [[Giardia lamblia infection|Giardia]] fecal antigen test is diagnostic.
*'''Miscellaneous'''
**Antibiotic-associated diarrhea
**[[Pseudomembranous colitis]]  
**[[Hemolytic-uremic syndrome|Hemolytic uremic syndrome]]  
**[[Neonatal drug withdrawal]]


*'''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, a positive history of travel, camping, infectious contacts, day care attendance, increased fecal leukocyte level, elevated erythrocyte sedimentation rate. Cultures or stained fecal smears for specific organisms are more definitive.
===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>===
 
*'''[[Ischemic colitis]]''':History of [[vascular]] disease and pain associated with eating. [[Colonoscopy]] and  abdominal [[arteriography]] is diagnostic.
 
*'''Miscellaneous'''; Antibiotic-associated diarrhea, [[pseudomembranous colitis]], toxins, [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]], [[neonatal drug withdrawal]]
 
===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>===
*'''Gastrointestinal drugs'''
*'''Gastrointestinal drugs'''
**[[Magnesium]] containing antacids
**[[Magnesium]] containing antacids
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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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