Chronic diarrhea causes

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 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

Watery diarrhea

• Osmotic diarrhea
  • Mg2+, PO43-, SO42- ingestion
  • Carbohydrate malabsorption
• Secretory diarrhea
  • Laxative abuse (nonosmotic laxatives)
  • Congenital syndromes
  • Bacterial toxins
  • Ileal bile acid malabsorption
  • Inflammatory bowel disease
    • Ulcerative colitis
    • Crohn’s disease
    • Microscopic (lymphocytic and collagenous) colitis
    • Diverticulitis
  • Vasculitis
  • Drugs and poisons
  • Disordered motility
    • Postvagotomy diarrhea
    • Postsympathectomy diarrhea
    • Diabetic autonomic neuropathy
    • Hyperthyroidism
    • 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

• Malabsorption syndromes
  • Mucosal diseases
  • Short-bowel syndrome
  • Postresection diarrhea
  • Mesenteric ischemia
• Maldigestion
  • Pancreatic insufficiency
  • Bile acid deficiency

Inflammatory diarrhea

• Inflammatory bowel disease
  • Ulcerative colitis
  • Crohn’s disease
  • Diverticulitis
  • Ulcerative jejunoileitis
• Infectious diseases
  • Ulcerating viral infections
    • Cytomegalovirus
    • Herpes simplex
• Ischemic colitis
• Radiation colitis
• Neoplasia
  • Colon cancer
  • Lymphoma

Drugs that commonly cause diarrhea

• Gastrointestinal drugs
  • Magnesium containing antacids
  • Laxatives
  • Cisapride
  • Olsalazine
• Cardiac drugs
  • Digitalis
  • Quinidine
  • Procainamide
  • Hydralazine
  • Beta-blockers
  • ACE inhibitors
  • Diuretics
• Antibiotics
  • Clindamycin
  • Ampicillin
  • Amoxycillin
  • Erythromycin
  • Cephalosporins
• Chemotherapeutic agents
• Hypolipidemic agents
  • Clofibrate
  • Gemfibrozil
  • Lovastatin
• Neuropsychiatric drugs
  • Lithium
  • Fluoxetine
  • Alprazolam
• Others
  • Aminophylline
  • Salbutamol
  • Non-steroidal anti-inflammatory drugs
  • Thyroid hormones
  • Colchicine