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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|Malabsorption]]''': Cystic fibrosis, celiac disease, disaccharidase deficiency (eg, lactase deficiency due to infectious diarrhea), acrodermatitis enteropathica, congenital secretory diarrhea
*'''[[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.
*'''[[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.
*[[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]].
* '''[[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.
*'''Gastrointestinal infections'''; such as [[viruses]], [[bacteria]] and [[parasites]].  
*'''Gastrointestinal infections'''; such as [[viruses]], [[bacteria]] and [[parasites]].  
*'''Non-gastrointestional infections''' (parenteral diarrhea);  systemic infections, staphylococcal toxic shock syndrome, urinary tract infections and other systemic infections.
*'''Non-gastrointestional infections''' (parenteral diarrhea);  systemic infections, staphylococcal toxic shock syndrome, urinary tract infections and other systemic infections.
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*'''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.
*'''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|'''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 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. [[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.
*
*'''Miscellaneous'''; Antibiotic-associated diarrhea, [[pseudomembranous colitis]], toxins, [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]], [[neonatal drug withdrawal]]
*'''Miscellaneous'''; Antibiotic-associated diarrhea, [[pseudomembranous colitis]], toxins, [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]], [[neonatal drug withdrawal]]


Revision as of 13:46, 22 June 2017

Chronic diarrhea Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chronic diarrhea from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

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 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]

  • 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.
  • 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.
  • Inflammatory bowel disease:May manifest as either 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), 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.
  • 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.
  • Gastrointestinal infections; such as viruses, bacteria and parasites.
  • Non-gastrointestional infections (parenteral diarrhea); systemic infections, staphylococcal toxic shock syndrome, urinary tract infections and other systemic infections.
  • Anatomic abnormalities; Intussusception, hirschsprung disease (± toxic megacolon) partial bowel obstruction, blind loop syndrome (also in patients with dysmotility), Intestinal lymphangiectasis, short gut syndrome.
  • Immunodeficiency; Severe combined immunodeficiencies and other genetic disorders, HIV
  • 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[2]

References

  1. ↑ Fine KD, Schiller LR (1999). "AGA technical review on the evaluation and management of chronic diarrhea". Gastroenterology. 116 (6): 1464–86. PMID 10348832.
  2. ↑ Branski D, Lerner A, Lebenthal E (1996). "Chronic diarrhea and malabsorption". Pediatr Clin North Am. 43 (2): 307–31. PMID 8614603.

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