Chronic diarrhea causes: Difference between revisions
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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 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]]). | ||
==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> | 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> | ||
*'''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. | *'''[[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. | *'''[[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 occult blood test|fecal leukocyte]] level, [[enzyme immunoassay]] that detects toxins A and B, positive fecal toxin assay and [[sigmoidoscopy]] demonstrating [[Pseudomembranous enterocolitis|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. | *'''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. | ||
*'''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. | *'''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 included [[thyroid-stimulating hormone]] level, serum peptide concentrations, urinary [[histamine]] level. | ||
*'''Giardiasis''': Patients presents with excess gas, steatorrhea (malabsorption). Giardia fecal antigen test is diagnostic. | *'''[[Giardiasis]]''': Patients presents with excess gas, [[steatorrhea]] (malabsorption). [[Giardia lamblia infection|Giardia]] fecal antigen test is diagnostic. | ||
*'''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 | *'''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. | ||
*'''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. | *[[Inflammatory bowel disease|'''Inflammatory bowel disease''':]] [[Crohn's 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]]), [[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]]. | ||
*'''Irritable bowel syndrome''': Patients present with | *'''[[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. | ||
*'''Ischemic colitis''':History of vascular disease and pain associated with eating. Colonoscopy and abdominal arteriography is diagnostic. | *'''[[Ischemic colitis]]''':History of [[vascular]] disease and pain associated with eating. [[Colonoscopy]] and abdominal [[arteriography]] is diagnostic. | ||
*'''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. | *'''[[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. | ||
===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>=== | ===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 | ||
**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== | ||
Revision as of 17:58, 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
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).
Causes
Some common causes of chronic diarrhea and their clinical findings include;[1]
- 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.
- 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.
- Giardiasis: Patients presents with excess gas, steatorrhea (malabsorption). Giardia fecal antigen test is diagnostic.
- 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.
- 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.
- 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.
- Ischemic colitis:History of vascular disease and pain associated with eating. Colonoscopy and abdominal arteriography is diagnostic.
- 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.
Drugs that commonly cause diarrhea[2]
- Gastrointestinal drugs
- Magnesium containing antacids
- Laxatives
- Cisapride
- Olsalazine
- Cardiac drugs
- Antibiotics
- Chemotherapeutic agents
- Hypolipidemic agents
- Neuropsychiatric drugs
- Others
References
- ↑ Fine KD, Schiller LR (1999). "AGA technical review on the evaluation and management of chronic diarrhea". Gastroenterology. 116 (6): 1464–86. PMID 10348832.
- ↑ Branski D, Lerner A, Lebenthal E (1996). "Chronic diarrhea and malabsorption". Pediatr Clin North Am. 43 (2): 307–31. PMID 8614603.