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==Overview==
==Overview==
Chronic diarrhea is a common symptom of many conditions with an estimated prevalence of 5%. Although chronic diarrhea has multiple definitions, a current working definition is the production of loose stools for longer than 4 weeks’ duration. Additional definitions include passage of 200 g of stool per day or passage of more than 3 bowel movements a day for 3 weeks.
Chronic [[diarrhea]] may be classified into 3 basic categories: [[Watery diarrhea|watery]], fatty ([[malabsorption]]), and [[inflammatory]] (with [[blood]] and [[pus]]). It is important to note that not all [[chronic diarrhea]] falls into one category alone. Classifying a patient's [[chronic diarrhea]] into a subcategory helps to direct the [[diagnostic]] workup.


==Classification==
==Classification==
Chronic diarrhea may be classified into  
Chronic [[diarrhea]] may be classified into:<ref name="FineSchiller1999">{{cite journal|last1=Fine|first1=K|last2=Schiller|first2=L|title=AGA Technical Review on the Evaluation and Management of Chronic Diarrhea☆|journal=Gastroenterology|volume=116|issue=6|year=1999|pages=1464–1486|issn=00165085|doi=10.1016/S0016-5085(99)70513-5}}</ref><ref>{{cite journal|title=American Gastroenterological Association medical position statement: Guidelines for the evaluation and management of chronic diarrhea☆, ☆☆|journal=Gastroenterology|volume=116|issue=6|year=1999|pages=1461–1463|issn=00165085|doi=10.1016/S0016-5085(99)70512-3}}</ref><ref name="pmid15017602">{{cite journal| author=Camilleri M| title=Chronic diarrhea: a review on pathophysiology and management for the clinical gastroenterologist. | journal=Clin Gastroenterol Hepatol | year= 2004 | volume= 2 | issue= 3 | pages= 198-206 | pmid=15017602 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15017602  }} </ref><ref name="pmid10699778">{{cite journal| author=Fine KD, Seidel RH, Do K| title=The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea. | journal=Gastrointest Endosc | year= 2000 | volume= 51 | issue= 3 | pages= 318-26 | pmid=10699778 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10699778  }} </ref>
*Inflammatory diarrhea
*[[Inflammatory|Inflammatory diarrhea]]
*Watery diarrhea
*[[Watery diarrhea]]
*Fatty diarrhea
*[[Steatorrhea|Fatty diarrhea]]


===Inflammatory diarrhea===
===Inflammatory diarrhea===
Diarrhea is said to be due to an inflammatory cause when stool analysis such as stool cultures, flexible sigmoidoscopy or colonoscopy with biopsies show evidence of the presence of fecal leukocytes. Causes of inflammatory disease include;
[[Diarrhea (patient information)|Diarrhea]] may be classified as [[inflammatory]], when [[Stool examination|stool analysis]] tools, such as [[Stool culture|stool cultures]] and interventions, such as [[flexible sigmoidoscopy]] or [[colonoscopy]] with [[biopsies]] show evidence of the presence of [[Fecal occult blood|fecal leukocytes]]. Causes of [[Inflammatory|inflammatory diarrhea]] include:
*Idiopathic inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
*[[Idiopathic]] [[inflammatory bowel disease]], such as [[Crohn’s disease]] or [[ulcerative colitis]]
*Infectious diseases such as cytomegalovirus, herpes simplex, tuberculosis, strongyloidiasis, Aeromonas or Plesiomonas
*[[Infectious disease|Infectious diseases]] such as:
*Ischemic colitis,
**[[Cytomegalovirus]]
*Radiation colitis, and
**[[Herpes simplex]]
*Neoplasia.  
**[[Tuberculosis]]
**[[Strongyloidiasis]]
**''[[Aeromonas]]''
**''[[Plesiomonas shigelloides|Plesiomonas]]''
*[[Ischemic colitis]]
*[[Radiation colitis]]
*[[Neoplasia]]
===Watery diarrhea===
Watery [[diarrhea]] can be classified as:
*Osmotic [[diarrhea]] ([[stools]] with high osmotic gap >100 mosm/kg). Causes of osmotic [[diarrhea]] include:
**[[Celiac sprue]]
**[[Chronic pancreatitis]]
**[[Lactase deficiency]]
**[[Lactulose]]
**[[Laxative abuse|Laxative use/abuse]] 
**[[Whipple's disease]]


*Secretory [[diarrhea]] ([[stools]] with low osmotic gap <50 mosm/kg). Causes of secretory [[diarrhea]] include:
**[[Cholera]]
**[[ETEC|Enterotoxigenic strains of ''E. coli'']]
**[[Medullary thyroid carcinoma]]
**[[Factitious disorders|Factitious diarrhea]] from [[laxative abuse]]<ref name="pmid7234824">{{cite journal| author=Oster JR, Materson BJ, Rogers AI| title=Laxative abuse syndrome. | journal=Am J Gastroenterol | year= 1980 | volume= 74 | issue= 5 | pages= 451-8 | pmid=7234824 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7234824  }} </ref>
**[[Villous adenoma]]
**''[[Aeromonas]]''
**''[[Plesiomonas shigelloides|Plesiomonas]]''
**[[Microsporidia]]
**''[[Giardia]]''
**[[Coccidia]]
**''[[Cryptosporidium]]''


===Watery diarhea===
* Structural and [[Endocrine system|endocrine]] [[diseases]] should also be considered. These [[diseases]] include the following:
Watery diarrhea can be classified as;
** [[Diabetes]]
*Osmotic diarrhea: this is the more common type however it has a limited differential diagnosis which includes;
** [[Hyperthyroidism]]
**Ingestion of exogenous magnesium,
** [[Addison's disease]]
**Carbohydrate malabsorption, or
** [[Peptide]] secreting [[endocrine tumors]]
**consumption of poorly absorbable carbohydrates.
Magnesium levels can be tested in the stool. A stool pH of less than 6 is suggestive of carbohydrate malabsorption.
*Secretory diarrhea : This is the less common type, the differential diagnosis of secretory diarrhea is quite vast. However, the incidence of these diseases is low. Some of the differentials include but are not limited to;
*Aeromonas
*Plesiomonas
*Microsporidia
*Giardia
*Coccidia
*Cryptosporidium,
Structural and Endocrine diseases should also be considered, including
*Diabetes
*Hyperthyroidism
*Addison’s disease
*eptide-secreting endocrine tumors


A normal gap is between 50 and 100 mosm/kg.<ref name="Shiau1985">{{cite journal|last1=Shiau|first1=Yih-Fu|title=Stool Electrolyte and Osmolality Measurements in the Evaluation of Diarrheal Disorders|journal=Annals of Internal Medicine|volume=102|issue=6|year=1985|pages=773|issn=0003-4819|doi=10.7326/0003-4819-102-6-773}}</ref>


===Fatty diarrhea===
===Fatty diarrhea===
Fatty diarrhea can be described either due to malabsorption or maldigestion problems;
Fatty [[diarrhea]] can be either due to [[malabsorption]] or [[maldigestion]] problems:
*Malabsorption; 3 most common causes of malabsorption are  
*The most common causes of [[malabsorption]] are:
**Celiac sprue
**[[Celiac sprue]]
**Pancreatic insufficiency
**[[Pancreatic insufficiency]]
**Bacterial overgrowth
**[[Bacterial overgrowth]]
*Maldigestion; Maldigestion results from pancreatic exocrine insufficiency
*[[Maldigestion]] results from [[Pancreatic insufficiency|pancreatic exocrine insufficiency]]


==References==
==References==
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[[Category:Emergency medicine]]
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[[Category:Gastroenterology]]
[[Category:Pediatrics]]
[[Category:Up-To-Date]]

Latest revision as of 13:21, 15 January 2021

Chronic diarrhea Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Overview

Chronic diarrhea may be classified into 3 basic categories: watery, fatty (malabsorption), and inflammatory (with blood and pus). It is important to note that not all chronic diarrhea falls into one category alone. Classifying a patient's chronic diarrhea into a subcategory helps to direct the diagnostic workup.

Classification

Chronic diarrhea may be classified into:[1][2][3][4]

Inflammatory diarrhea

Diarrhea may be classified as inflammatory, when stool analysis tools, such as stool cultures and interventions, such as flexible sigmoidoscopy or colonoscopy with biopsies show evidence of the presence of fecal leukocytes. Causes of inflammatory diarrhea include:

Watery diarrhea

Watery diarrhea can be classified as:

A normal gap is between 50 and 100 mosm/kg.[6]

Fatty diarrhea

Fatty diarrhea can be either due to malabsorption or maldigestion problems:

References

  1. Fine, K; Schiller, L (1999). "AGA Technical Review on the Evaluation and Management of Chronic Diarrhea☆". Gastroenterology. 116 (6): 1464–1486. doi:10.1016/S0016-5085(99)70513-5. ISSN 0016-5085.
  2. "American Gastroenterological Association medical position statement: Guidelines for the evaluation and management of chronic diarrhea☆, ☆☆". Gastroenterology. 116 (6): 1461–1463. 1999. doi:10.1016/S0016-5085(99)70512-3. ISSN 0016-5085.
  3. Camilleri M (2004). "Chronic diarrhea: a review on pathophysiology and management for the clinical gastroenterologist". Clin Gastroenterol Hepatol. 2 (3): 198–206. PMID 15017602.
  4. Fine KD, Seidel RH, Do K (2000). "The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea". Gastrointest Endosc. 51 (3): 318–26. PMID 10699778.
  5. Oster JR, Materson BJ, Rogers AI (1980). "Laxative abuse syndrome". Am J Gastroenterol. 74 (5): 451–8. PMID 7234824.
  6. Shiau, Yih-Fu (1985). "Stool Electrolyte and Osmolality Measurements in the Evaluation of Diarrheal Disorders". Annals of Internal Medicine. 102 (6): 773. doi:10.7326/0003-4819-102-6-773. ISSN 0003-4819.


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