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	Small intestinal bacterial overgrowth syndrome;
ICD-10	K63
ICD-9	579.9
DiseasesDB	29209
MedlinePlus	000222
eMedicine	med/198

VisualWikitext

Revision as of 19:06, 29 January 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Historical Perspective

Small intestinal bacterial overgrowth (SIBO) was first discovered by Barber and Hummel in 1939.
In 2000, Pimentel et all at Cedars-Sinai Medical Center were first identified that SIBO was present in 78% of patients with irritable bowel syndrome (IBS), and that treatment with antibiotics improved symptoms.
In May 2015, U.S. Food and Drug Administration (FDA) approved rifaximin to treat SIBO.

Classification

There is no established system for the classification of small intestinal bacterial overgrowth(SIBO).

Pathophysiology

The pathogenesis of small intestinal bacterial overgrowth (SIBO) is characterized by an increased microbial load in the small intestine.
A healthy individual has less than 103 organisms/mL in the upper small intestine, and the majority of these organisms are gram-positive bacteria.
Body's homeostatic mechanisms protect against excessive small intestinal colonization by bacteria include :
- Gastric acid and bile eradicate micro-organisms before they leave the stomach
- Migrating motor complex clears the excess unwanted bacteria of upper intestine
- Intestinal mucosa serves as a protective layer for the gut wall.
- Normal intestinal flora (eg, Lactobacillus) maintains a low pH that prevents bacterial overgrowth.
- Physical barrier of the ileocecal valve that prevents retrograde translocation of bacteria from colon to the small intestine.
Disruption of these protective homeostatic mechanisms can increase the risk of SIBO.
Bacterial colonization causes an inflammatory response in the intestinal mucosa.
Damage to the intestinal mucosa leads to malabsorption of bile acids, carbohydrates, proteins and vitamins resulting in symptoms of diarrhea and weightloss.
On gross pathology, mucosal edema, loss of normal vascular pattern, patchy erythema, friability and ulceration of the small intestinal wall is associated with small intestinal bacterial overgrowth (SIBO).
On microscopic histopathological analysis small intestine and colon is normal in most patients with SIBO. Findings include:
- Blunting of the intestinal villi
- Thinning of the mucosa and crypts
- Increased intraepithelial lymphocytes==Causes==
Small intestinal bacterial overgrowth (SIBO) may be caused by disruption of the protective homeostatic mechanisms that control enteric bacteria population.
Causes of small intestinal bacterial overgrowth (SIBO) include:
- Irregular small intestinal motility
  - Diabetic autonomic neuropathy
  - Scleroderma
  - Pseudo-obstruction
  - Amyloidosis
  - Neurological diseases (eg, myotonic dystrophy, Parkinson disease)
  - Radiation enteritis
  - Crohn disease
  - Hypothyroidism
- Blind pouches in the gastrointestinal tract
  - Side-to-side or end-to-side anastomoses
  - Duodenal or jejunal diverticula
  - Segmental dilatation of the ileum
  - Blind loop syndrome
  - Biliopancreatic diversion
  - Chagasic megacolon
- Fistula
  - Gastrocolic fistulae
  - Jejunal-colic fistulae
- Partial Obstruction
  - Strictures
  - Adhesions
  - Abdominal masses
  - Leiomyosarcoma
- Decreased gastric acid secretion
  - Achlorhydria
  - Vagotomy
  - Long-term proton pump inhibitor therapy

Differentiating [disease name] from other Diseases

Small intestinal bacterial overgrowth (SIBO) must be differentiated from other diseases that cause chronic diarrhea.

The following table outlines the major differential diagnoses of chronic diarrhea.^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]^[17]^[18]^[19]^[20]^[21]^[22]^[23]^[24]^[25]^[26]^[27]^[28]^[29]^[30]

Abbreviations: GI: Gastrointestinal, CBC: Complete blood count, WBC: White blood cell, RBC: Red blood cell, Plt: Platelet, Hgb: Hemoglobin, ESR: Erythrocyte sedimentation rate, CRP: C–reactive protein, IgE: Immunoglobulin E, IgA: Immunoglobulin A, ETEC: Escherichia coli enteritis, EPEC: Enteropathogenic Escherichia coli, EIEC: Enteroinvasive Escherichia coli, EHEC: Enterohemorrhagic Escherichia coli, EAEC: Enteroaggregative Escherichia coli, Nl: Normal, ASCA: Anti saccharomyces cerevisiae antibodies, ANCA: Anti–neutrophil cytoplasmic antibody, DNA: Deoxyribonucleic acid, CFTR: Cystic fibrosis transmembrane conductance regulator, SLC10A2: Solute carrier family 10 member 2, SeHCAT: Selenium homocholic acid taurine or tauroselcholic acid, IEL: Intraepithelial lymphocytes, MRCP: Magnetic resonance cholangiopancreatography, ANA: Antinuclear antibodies, AMA: Anti-mitochondrial antibody, LDH: Lactate dehydrogenase, CPK: Creatine phosphokinase, PCR: Polymerase chain reaction, ELISA: Enzyme–linked immunosorbent assay, LT: Heat–labile enterotoxin, ST: Heat–stable enterotoxin, RT-PCR: Reverse–transcriptase polymerase chain reaction, CD4: Cluster of differentiation 4, HIV: Human immunodeficiency virus, RUQ: Right-upper quadrant, VIP: Vasoactive intestinal peptide, GI: Gastrointestinal, FAP: Familial adenomatous polyposis, HNPCC: Hereditary nonpolyposis colorectal cancer, MTP: Microsomal triglyceride transfer protein, Scl‑70: Anti–topoisomerase I, TSH: Thyroid-stimulating hormone, T4: Thyroxine, T3: Triiodothyronine, DTR: Deep tendon reflex, RNA: Ribonucleic acid

		Symptoms								GI signs
Cause		Clinical manifestation									Lab findings									Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Duration		Diarrhea			Fever	Abdominal pain	Weight loss
		Duration		Diarrhea							Stool exam					CBC			Other lab findings
		Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings
Crohn's disease		–	+	+	+	+	±	+	+	Abdominal tenderness Oral mucosal lesions	+	+	–	Nl	–	↑	↓	↑	Anti saccharomyces cerevisiae antibodies (ASCA) Vitamin B12 deficiency Elevated ESR Elevated CRP	Uveitis Arthritis Erythema nodosum Pyoderma gangrenosum Amyloidosis Venous and arterial thromboembolism Renal stones Bronchiectasis	Abnormal immune response to self antigens	Colonoscopy with biopsy
Ulcerative colitis		–	+	+	+	+	±	+	+	Abdominal tenderness Blood on rectal examination	+	+	–	Nl	–	↑	↓	↑	Anti–neutrophil cytoplasmic antibody (P–ANCA) Hypoalbuminemia Hypokalemia Hypomagnesemia Elevated ESR Elevated CRP	Skin rash Iritis Uveitis Seronegative arthritis Clubbing Erythema nodosum	Abnormal immune response to self antigens	Colonoscopy with biopsy
Celiac disease		–	+	±	–	±	–	+	+	Abdominal distention Increased bowel sounds Oral mucosal lesions Hepatosplenomegaly Ascites	–	–	–	Nl	Fat droplets on sudan stain	Nl	↓	Nl	IgA endomysial antibody Anti–tissue transglutaminase antibody Anti–gliadin antibody Fat soluble vitamins deficiency	Malabsorption Dementia Dermatitis herpetiformis	HLA–DQ2 HLA–DQ8 Innate responses to wheat proteins	IgA endomysial antibody Anti–tissue transglutaminase antibody
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cystic fibrosis		–	+	–	–	+	±	+	+	Abdominal distention Hepatosplenomegaly Rectal prolapse	–	–	–	Nl	Fat droplets on sudan stain	Nl	↓	Nl	Positive DNA analysis for cystic fibrosis transmembrane conductance regulator (CFTR) Nasal transepithelial potential difference Fat soluble vitamins deficiency	Malabsorption Recurrent respiratory tract infection Bronchiectasis Diabetes mellitus Scoliosis Infertility	Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein	Positive genetic testing Elevated sweat chloride ≥60 mmol/L
Chronic pancreatitis		–	+	+	–	+	–	+	+	Abdominal tenderness	–	–	–	Nl	Fat droplets on sudan stain Positive fecal elastase measurement	Nl	Nl	Nl	Slightly elevated amylase and lipase Abnormal pancreatic function test Secretin stimulation test	Malabsorption Diabetes mellitus Pancreatic pseudocyst	Toxins Recurrent acute pancreatitis Genetic predesposition Autoimmune	Magnetic resonance cholangiopancreatography (MRCP)
Bile acid malabsorption		–	+	+	–	+	–	–	+		–	–	–	Nl	Fat droplets on sudan stain	Nl	Nl	Nl	Reduced cholesterol level	Malabsorption Hypotension Tachycardia	Genetic defects in SLC10A2	SeHCAT test
Microscopic colitis		–	+	+	–	–	–	+	+	Abdominal tenderness Fecal incontinence	–	–	–	Nl	–	Nl	↓	Nl	Hypokalemia Elevated CRP Positive autoantibodies include: RF ANA AMA ANCA	Arthritis Uveitis Idiopathic thrombocytopenic purpura Pleuro pericarditis Hypothyroidism Psoriasis	Mucosal immune responses to luminal factors in a genetically predisposed individual Drug–induced	Colonoscopy with mucosal biopsy with mononuclear infiltrates: Collagenous colitis is characterized by a colonic subepithelial collagen band >10 micrometers in diameter Lymphocytic colitis is characterized by ≥20 intraepithelial lymphocytes (IEL) per 100 surface epithelial cells
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Infective colitis		–	+	+	+	–	+	+	+	Rebound abdominal tenderness	+	+	+	Nl	Positive stool culture Positive fecal calprotectin Positive fecal lactoferrin	↑	↓	↑	Elevated CRP Elevated ESR	Arthritis Uveitis	Salmonella Shigella Campylobacter E. coli 0157:H7 Clostridium difficile Entamoeba histolytica Adenovirus Cytomegalovirus Herpes simplex virus	Stool culture Blood culture
Ischemic colitis		+	+	+	+	–	+	+	+	Hyperactive then absent bowel sounds Abdominal tenderness	+	+	–	Nl	–	↑	↓	↑	Elevated CRP Elevated ESR Elevated serum lactate Elevated lactate dehydrogenase (LDH) Elevated creatine phosphokinase (CPK) Elevated amylase Hypoalbuminemia	IgA vasculitis	Hypercoagulability Nonocclusive colonic ischemia Embolic and thrombotic arterial occlusion Mesenteric vein thrombosis	Abdominal CT scan
Lactose intolerance		+	+	+	–	–	–	+	–	Abdominal tenderness Abdominal distention	–	–	–	↑	–	Nl	Nl	Nl	Lactose tolerance test Genetic testing	Headache Vertigo Memory impairment Lethargy	Reduction of lactase enzyme activity or inability to produce persistent lactase Congenital lactase deficiency Secondary lactose malabsorption	Small bowel biopsy Lactose breath hydrogen test
Irritable bowel syndrome		–	+	±	–	±	–	±	–	Abdominal tenderness Abdominal distention Normal bowel sounds	–	–	–	Nl	–	Nl	Nl	Nl	Nl	Anxiety Palpitation	Unknown	Diagnosis of exclusion
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Whipple's disease		–	+	+	–	+	±	+	+	Hepatosplenomegaly Ascites	–	–	–	Nl	Positive fecal fat	↓	↓	↓/↑	Hypoalbuminemia Fat soluble vitamins deficiency	Malabsorption Abnormal extraocular movement Lymphadenopathy Hyperpigmentation Uveitis Endocarditis Encephalitis Dementia Pleural effusion	Tropheryma whipplei	Small intestine biopsy for Tropheryma whipplei testing PCR testing
Tropical sprue		+	+	+	–	+	+	+	+	Angular stomatitis Oral mucosal lesion	+	–	–	Nl	Positive stool culture	Nl	↓	Nl	Fat soluble vitamins deficiency Vitamin B12 deficiency Folate deficiency Hypokalemia	Myalgia Neuropathy Edema	Escherichia coli Klebsiella pneumoniae Enterobacter cloacae	Diagnosis of exclusion
Small bowel bacterial overgrowth		–	+	+	–	+	–	+	+	Abdominal distention	+	–	–	Nl	Positive stool culture Positive fecal fat	Nl	↓	Nl	Hypoalbuminemia Abnormal hydrogen breath test Lactic acidosis	Malabsorption Rosacea	Excess bacteria in the small intestine Alterations in intestinal anatomy or GI motility	Diagnosis of exclusion
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Salmonellosis		+	+	+	+	–	+	+	–	Abdominal distention Diffuse abdominal tenderness Hepatosplenomegaly	+	+	–	Nl	Positive stool culture Positive serologic testing	↑	Nl	↑	Hypokalemia Hypernatremia Hyponatremia Hypercalciuria Hypocitraturia	Post–infectious arthritis Obtundation Bacteremia Pericarditis Pyelonephritis Brain abscess	Salmonella	Stool culture
Escherichia coli enteritis	EPEC	+	+	+	+	–	+	+	+	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	–	Enteropathogenic E. coli	DNA probe or polymerase chain reaction (PCR) of the EPEC adherence factor Stool culture
Escherichia coli enteritis	EAEC	+	+	+	+	–	–	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	↓	↓	–	Chronic infection in immunocompromised patients	Enteroaggregative E. coli	Stool culture
Aeromonas		+	+	+	+	–	+	+	–	Abdominal distention Hyperactive bowel sounds Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	Wound infection Bacteremia Hemolytic uremic syndrome Meningitis Ocular infection Pneumonia Urinary tract infection Osteomyelitis Peritonitis Acute cholecystitis Opportunistic infections in immunocompromised patients	Aeromonas virulence factors including endotoxins, hemolysins, enterotoxins, and adherence factors	Blood culture Wound culture
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Mycobacterium avium complex		+	+	+	+	–	+	+	–	Abdominal distention Hepatosplenomegaly	+	+	–	Nl	–	↓	↓	Nl	Elevated liver enzymes	Opportunistic infection in immunocompromised patients Pulmonary infection Adenopathy Night sweats	Mycobacterium avium complex	Blood culture
CMV colitis		+	+	–	+	–	±	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Viral antigen assay	↓	Nl	Nl	Decreased CD4 level Abnormal liver function test	Encephalitis Guillain–Barré syndrome Pneumonia Retinitis Pericarditis and myocarditis Atherosclerosis Venous thrombosis	Cytomegalovirus	Quantitative PCR tests
HIV		–	+	+	–	–	+	+	+	Abdominal distention Diffuse abdominal tenderness	+	–	–	Nl	–	↓	↓	Nl	Decreased CD4 level Electrolyte imbalance	Lymphadenopathy Disseminated infection	HIV	HIV virologic (viral load) test Immunoassay
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Entamoeba histolytica		+	+	+	+	–	+	+	–	Abdominal distention Diffuse abdominal tenderness	+	+	+	Nl	–	↑	Nl	Nl	–	Liver abscess Pleuropulmonary infection Cardiac infection Brain abscess Cutaneous infection	Entamoeba histolytica	Antigen testing Serology
Giardia		–	+	+	–	+	–	+	+	Abdominal distention Diffuse abdominal tenderness	–	–	+	Nl	–	Nl	Nl	Nl	–	Malabsorption Urticaria Depression	Giardia lamblia	Antigen detection assays
Cryptosporidium		–	+	+	–	–	–	+	+	Abdominal distention Diffuse abdominal tenderness	–	–	+	Nl	Positive stool microscopy	Nl	Nl	Nl	Elevated alkaline phosphatase	Chronic, life–threatening illness in immunocompromised patients	Cryptosporidium	Polymerase chain reaction
Microsporidia		+	+	+	–	–	+	+	–	Abdominal distention Diffuse abdominal tenderness	–	–	+	Nl	Positive stool microscopy	Nl	Nl	Nl	Decreased CD4 count	Malabsorption Keratitis Seizure Myositis	Microsporidia	Antigen detection assays
Isospora		+	+	+	–	+	+	+	+	Abdominal distention Diffuse abdominal tenderness	+	+	+	Nl	Positive stool microscopy Positive fecal fat	↑	Nl	Nl	Elevated eosinophils Hypokalemia Increased creatinine	Chronic illness in immunocompromised patients	Isospora	Detecting oocysts in the feces
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Carcinoid tumor		–	+	+	+	–	–	+	+	Abdominal distention	–	+	–	↓	–	Nl	Nl	Nl	Elevated urinary 5–hydroxyindoleacetic acid (5–HIAA) level High chromogranin A	Facial flushing Jaundice Edema Valvular heart disease Right–sided heart failure	Well–differentiated neuroendocrine tumor	Blood chromogranin A level
VIPoma		+	+	+	–	+	–	+	+	Abdominal distention Abdominal RUQ tenderness Nausea Vomiting	–	–	–	↓	–	Nl	Nl	Nl	Elevated VIP level Hypokalemia Hypochlorhydria or achlorhydria Low osmotic gap (<50 mOsm/kg)	Rash Facial flushing Dehydration Lethargy Muscle weakness	Primary secretory tumor	Blood VIP levels Followed by imaging
Zollinger–Ellison syndrome		–	+	+	+	+	–	+	+	Epigastric tenderness	–	–	–	↓	–	Nl	↓	Nl	Positive secretin stimulation test Elevated serum chromogranin A	Jaundice	Gastrin producing tumor mainly in duodenum	Secretin stimulation test
Somatostatinoma		–	+	+	–	–	–	+	+	Epigastric tenderness	–	–	–	↓	–	Nl	Nl	Nl	Elevated fasting plasma somatostatin	Diabetes mellitus Cholelithiasis Jaundice	Neuroendocrine tumors of D–cell origin	Plasma somatostatin level Followed by imaging
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Lymphoma		–	+	+	+	–	+	+	+	Diffuse abdominal tenderness Hepatosplenomegaly	–	+	–	Nl	–	Nl	↓	Nl	Paraproteinemia	Malabsorption Lactose intolerance Ascites	Primary tumor of GI tract	Colonoscopy with biopsy
Colorectal cancer		–	+	+	+	+	–	+	+	Diffuse abdominal tenderness	–	+	–	Nl	–	Nl	↓	Nl	Positive carcinoembryonic antigen	Metastasis	FAP gene HNPCC gene	Colonoscopy and biopsy
Medications ACE inhibitors Digoxin Cephalosporins Statins Thiazide diuretics Triptans Lactulose Anti retroviral agents Chemotherapeutic agents Antifungals Magnesium		+	+	+	–	±	±	+	+	Abdominal distention Dehydration	–	–	–	↑/↓	–	↑	Nl	Nl	Elevated plasma level of drug	–	Inflammation Pseudomembranous colitis	Clinical evaluation after discontinuation of the drugs
Factitious diarrhea		+	+	+	–	–	–	+	+	Abdominal distention	–	–	–	↑/↓	–	Nl	Nl	Nl	Hypokalemia Metabolic alkalosis Hypermagnesemia	Malabsorption Lethargy Generalized weakness Acute renal failure	Medications	Clinical evaluation after discontinuation of the drugs
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Heavy metal ingestion		–	+	+	–	–	–	+	+	Abdominal distention	–	–	–	Nl	–	Nl	Nl	Nl	Elevated plasma heavy metal level	Headache Numbness Alopecia Vertigo	Heavy metal ingestion	Plasma level of heavy metal
Organophosphate poisoning		+	+	+	–	–	–	+	–	Salivation Vomiting	–	–	–	Nl	–	Nl	Nl	Nl	Reduced RBC acetylcholinesterase Plasma cholinesterase activity	Autonomic dysfunction Motor deficit Sensory deficit Bronchospasm Urination Miosis Bradycardia Lacrimation Sweating Cardiac arrhythmias Acute renal injury	Neurotoxins bind to acetylcholinesterase (AChE)	Clinical diagnosis
Opium withdrawal		+	+	+	–	–	–	+	–	Hyperactive bowel sounds	–	–	–	Nl	–	Nl	Nl	Nl	Azotemia Hypokalemia Metabolic alkalosis	Dysphoria Restlessness Sweating Rhinorrhea Lacrimation Myalgia Arthralgia	Opium withdrawal	Clinical diagnosis following opium withdrawal
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Short bowel syndrome		+	+	+	–	+	–	–	+	Abdominal distention Abdominal tenderness	–	–	–	Nl	Positive fecal fat	Nl	↓	↑	Hypoalbuminemia High level of acute phase reactant Abnormal liver function tests	Prior intestinal surgery Malabsorption Crohn's disease Malignancy Peripheral edema Muscle atrophy	Surgical bowel resection	Clinical diagnosis following bowel resection
Radiation enteritis		+	+	+	+	+	–	+	+	Abdominal tenderness	+	+	–	Nl	Positive fecal fat	Nl	↓	Nl	Vitamin B12 deficiency Hypoalbuminemia	Prior history of malignancy and radiation therapy Malabsorption Telangiectasias	Radiation	Segmental bowel inflammation on endoscopy or colonoscopy
Dumping syndrome		–	+	+	–	+	–	–	+	Hyperactive bowel sound	–	–	–	Nl	–	Nl	Nl	Nl	Hypoglycemia Hydrogen breath test	Malnutrition Fat soluble vitamin deficiency	Postgastrectomy	Clinical diagnosis following gastrectomy
Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
Abetalipoproteinemia		–	+	+	–	+	–	+	+	Abdominal distension	–	–	–	Nl	–	Nl	Nl	Nl	Low triglyceride Low total cholesterol levels Acanthocytes Low vitamin E levels	Ataxia Visual field defect Dysarthria	Autosomal recessive disorder caused by mutations encoding the microsomal triglyceride transfer protein (MTP)	Clinical findings and low triglyceride and cholesterol level
Hyperthyroidism		–	+	+	–	–	±	+	+	–	–	–	–	Nl	Positive fecal fat	Nl	Nl	Nl	Elevated T4 Elevated T3 Decreased TSH High serum alkaline phosphatase	Lump in the neck Lid lag Malabsorption Sweating Hyperpigmentation Proptosis Tremor Increased DTR	Graves' disease Hashimoto's thyroiditis Toxic adenoma	TSH
Diabetic neuropathy		–	+	+	–	+	–	+	+	Fecal incontinence	–	–	–	Nl	Positive fecal fat	Nl	↓	Nl	Hyperglycemia Azotemia Hypokalemia	Malabsorption	Unclear Disordered motility Increased intestinal secretion Small intestinal bacterial overgrowth	Clinical diagnosis in a patient with long lasting diabetes mellitus
Systemic sclerosis		–	+	+	±	+	–	+	+	Epigastric tenderness Fecal incontinence	–	+	–	Nl	Positive fecal fat	Nl	↓	Nl	Anti–topoisomerase I (Scl‑70) antibodies Antinuclear antibodies (ANA) Anti–centromere antibodies Anti–RNA polymerase III antibody	Malabsorption Skin changes Raynaud phenomenon Pulmonary hypertension Arthritis Telangiectasia Chronic renal failure	Autoimmune reaction	Clinical diagnosis Followed by serologic tests

References

↑ Casburn-Jones, Anna C; Farthing, Michael Jg (2004). "Traveler's diarrhea". Journal of Gastroenterology and Hepatology. 19 (6): 610–618. doi:10.1111/j.1440-1746.2003.03287.x. ISSN 0815-9319.
↑ Kamat, Deepak; Mathur, Ambika (2006). "Prevention and Management of Travelers' Diarrhea". Disease-a-Month. 52 (7): 289–302. doi:10.1016/j.disamonth.2006.08.003. ISSN 0011-5029.
↑ Pfeiffer, Margaret L.; DuPont, Herbert L.; Ochoa, Theresa J. (2012). "The patient presenting with acute dysentery – A systematic review". Journal of Infection. 64 (4): 374–386. doi:10.1016/j.jinf.2012.01.006. ISSN 0163-4453.
↑ Barr W, Smith A (2014). "Acute diarrhea". Am Fam Physician. 89 (3): 180–9. PMID 24506120.
↑ Amil Dias J (2017). "Celiac Disease: What Do We Know in 2017?". GE Port J Gastroenterol. 24 (6): 275–278. doi:10.1159/000479881. PMID 29255768.
↑ Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi A (2017). "Shigellosis". Lancet. doi:10.1016/S0140-6736(17)33296-8. PMID 29254859. Vancouver style error: initials (help)
↑ Yamamoto-Furusho, J.K.; Bosques-Padilla, F.; de-Paula, J.; Galiano, M.T.; Ibañez, P.; Juliao, F.; Kotze, P.G.; Rocha, J.L.; Steinwurz, F.; Veitia, G.; Zaltman, C. (2017). "Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation". Revista de Gastroenterología de México. 82 (1): 46–84. doi:10.1016/j.rgmx.2016.07.003. ISSN 0375-0906.
↑ Borbély, Yves M; Osterwalder, Alice; Kröll, Dino; Nett, Philipp C; Inglin, Roman A (2017). "Diarrhea after bariatric procedures: Diagnosis and therapy". World Journal of Gastroenterology. 23 (26): 4689. doi:10.3748/wjg.v23.i26.4689. ISSN 1007-9327.
↑ Crawford, Sue E.; Ramani, Sasirekha; Tate, Jacqueline E.; Parashar, Umesh D.; Svensson, Lennart; Hagbom, Marie; Franco, Manuel A.; Greenberg, Harry B.; O'Ryan, Miguel; Kang, Gagandeep; Desselberger, Ulrich; Estes, Mary K. (2017). "Rotavirus infection". Nature Reviews Disease Primers. 3: 17083. doi:10.1038/nrdp.2017.83. ISSN 2056-676X.
↑ Kist M (2000). "[Chronic diarrhea: value of microbiology in diagnosis]". Praxis (Bern 1994) (in German). 89 (39): 1559–65. PMID 11068510.
↑ Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH (1985). "Evaluation and diagnosis of acute infectious diarrhea". Am. J. Med. 78 (6B): 91–8. PMID 4014291.
↑ López-Vélez R, Turrientes MC, Garrón C, Montilla P, Navajas R, Fenoy S, del Aguila C (1999). "Microsporidiosis in travelers with diarrhea from the tropics". J Travel Med. 6 (4): 223–7. PMID 10575169.
↑ Wahnschaffe, Ulrich; Ignatius, Ralf; Loddenkemper, Christoph; Liesenfeld, Oliver; Muehlen, Marion; Jelinek, Thomas; Burchard, Gerd Dieter; Weinke, Thomas; Harms, Gundel; Stein, Harald; Zeitz, Martin; Ullrich, Reiner; Schneider, Thomas (2009). "Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas". Scandinavian Journal of Gastroenterology. 42 (3): 391–396. doi:10.1080/00365520600881193. ISSN 0036-5521.
↑ Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA (2017). "75SeHCAT scan in bile acid malabsorption in chronic diarrhoea". Rev Esp Med Nucl Imagen Mol. 36 (1): 37–47. doi:10.1016/j.remn.2016.08.005. PMID 27765536.
↑ Gibson RJ, Stringer AM (2009). "Chemotherapy-induced diarrhoea". Curr Opin Support Palliat Care. 3 (1): 31–5. doi:10.1097/SPC.0b013e32832531bb. PMID 19365159.
↑ Abraham BP, Sellin JH (2012). "Drug-induced, factitious, & idiopathic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 633–48. doi:10.1016/j.bpg.2012.11.007. PMID 23384808.
↑ Reintam Blaser A, Deane AM, Fruhwald S (2015). "Diarrhoea in the critically ill". Curr Opin Crit Care. 21 (2): 142–53. doi:10.1097/MCC.0000000000000188. PMID 25692805.
↑ McMahan ZH, DuPont HL (2007). "Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy". Aliment. Pharmacol. Ther. 25 (7): 759–69. doi:10.1111/j.1365-2036.2007.03261.x. PMID 17373914.
↑ Schiller LR (2012). "Definitions, pathophysiology, and evaluation of chronic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 551–62. doi:10.1016/j.bpg.2012.11.011. PMID 23384801.
↑ Giannella RA (1986). "Chronic diarrhea in travelers: diagnostic and therapeutic considerations". Rev. Infect. Dis. 8 Suppl 2: S223–6. PMID 3523719.
↑ 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.
↑ Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.
↑ Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.
↑ RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.
↑ Konvolinka CW (1994). "Acute diverticulitis under age forty". Am J Surg. 167 (6): 562–5. PMID 8209928.
↑ Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006). "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications". Gut. 55 (6): 749–53. doi:10.1136/gut.2005.082909. PMC 1856208. PMID 16698746.
↑ Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003). "Amebiasis". N Engl J Med. 348 (16): 1565–73. doi:10.1056/NEJMra022710. PMID 12700377.
↑ Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.
↑ Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.
↑ BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.

External links

IBS and small intestinal bacterial overgrowth (SIBO)

Template:WikiDoc Sources

[Casburn-JonesFarthing2004-1] Casburn-Jones, Anna C; Farthing, Michael Jg (2004). "Traveler's diarrhea". Journal of Gastroenterology and Hepatology. 19 (6): 610–618. doi:10.1111/j.1440-1746.2003.03287.x. ISSN 0815-9319.

[KamatMathur2006-2] Kamat, Deepak; Mathur, Ambika (2006). "Prevention and Management of Travelers' Diarrhea". Disease-a-Month. 52 (7): 289–302. doi:10.1016/j.disamonth.2006.08.003. ISSN 0011-5029.

[PfeifferDuPont2012-3] Pfeiffer, Margaret L.; DuPont, Herbert L.; Ochoa, Theresa J. (2012). "The patient presenting with acute dysentery – A systematic review". Journal of Infection. 64 (4): 374–386. doi:10.1016/j.jinf.2012.01.006. ISSN 0163-4453.

[pmid24506120-4] Barr W, Smith A (2014). "Acute diarrhea". Am Fam Physician. 89 (3): 180–9. PMID 24506120.

[pmid29255768-5] Amil Dias J (2017). "Celiac Disease: What Do We Know in 2017?". GE Port J Gastroenterol. 24 (6): 275–278. doi:10.1159/000479881. PMID 29255768.

[pmid29254859-6] Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi A (2017). "Shigellosis". Lancet. doi:10.1016/S0140-6736(17)33296-8. PMID 29254859. Vancouver style error: initials (help)

[Yamamoto-FurushoBosques-Padilla2017-7] Yamamoto-Furusho, J.K.; Bosques-Padilla, F.; de-Paula, J.; Galiano, M.T.; Ibañez, P.; Juliao, F.; Kotze, P.G.; Rocha, J.L.; Steinwurz, F.; Veitia, G.; Zaltman, C. (2017). "Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation". Revista de Gastroenterología de México. 82 (1): 46–84. doi:10.1016/j.rgmx.2016.07.003. ISSN 0375-0906.

[BorbélyOsterwalder2017-8] Borbély, Yves M; Osterwalder, Alice; Kröll, Dino; Nett, Philipp C; Inglin, Roman A (2017). "Diarrhea after bariatric procedures: Diagnosis and therapy". World Journal of Gastroenterology. 23 (26): 4689. doi:10.3748/wjg.v23.i26.4689. ISSN 1007-9327.

[CrawfordRamani2017-9] Crawford, Sue E.; Ramani, Sasirekha; Tate, Jacqueline E.; Parashar, Umesh D.; Svensson, Lennart; Hagbom, Marie; Franco, Manuel A.; Greenberg, Harry B.; O'Ryan, Miguel; Kang, Gagandeep; Desselberger, Ulrich; Estes, Mary K. (2017). "Rotavirus infection". Nature Reviews Disease Primers. 3: 17083. doi:10.1038/nrdp.2017.83. ISSN 2056-676X.

[pmid11068510-10] Kist M (2000). "[Chronic diarrhea: value of microbiology in diagnosis]". Praxis (Bern 1994) (in German). 89 (39): 1559–65. PMID 11068510.

[pmid4014291-11] Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH (1985). "Evaluation and diagnosis of acute infectious diarrhea". Am. J. Med. 78 (6B): 91–8. PMID 4014291.

[pmid10575169-12] López-Vélez R, Turrientes MC, Garrón C, Montilla P, Navajas R, Fenoy S, del Aguila C (1999). "Microsporidiosis in travelers with diarrhea from the tropics". J Travel Med. 6 (4): 223–7. PMID 10575169.

[WahnschaffeIgnatius2009-13] Wahnschaffe, Ulrich; Ignatius, Ralf; Loddenkemper, Christoph; Liesenfeld, Oliver; Muehlen, Marion; Jelinek, Thomas; Burchard, Gerd Dieter; Weinke, Thomas; Harms, Gundel; Stein, Harald; Zeitz, Martin; Ullrich, Reiner; Schneider, Thomas (2009). "Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas". Scandinavian Journal of Gastroenterology. 42 (3): 391–396. doi:10.1080/00365520600881193. ISSN 0036-5521.

[pmid27765536-14] Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA (2017). "75SeHCAT scan in bile acid malabsorption in chronic diarrhoea". Rev Esp Med Nucl Imagen Mol. 36 (1): 37–47. doi:10.1016/j.remn.2016.08.005. PMID 27765536.

[pmid19365159-15] Gibson RJ, Stringer AM (2009). "Chemotherapy-induced diarrhoea". Curr Opin Support Palliat Care. 3 (1): 31–5. doi:10.1097/SPC.0b013e32832531bb. PMID 19365159.

[pmid23384808-16] Abraham BP, Sellin JH (2012). "Drug-induced, factitious, & idiopathic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 633–48. doi:10.1016/j.bpg.2012.11.007. PMID 23384808.

[pmid25692805-17] Reintam Blaser A, Deane AM, Fruhwald S (2015). "Diarrhoea in the critically ill". Curr Opin Crit Care. 21 (2): 142–53. doi:10.1097/MCC.0000000000000188. PMID 25692805.

[pmid17373914-18] McMahan ZH, DuPont HL (2007). "Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy". Aliment. Pharmacol. Ther. 25 (7): 759–69. doi:10.1111/j.1365-2036.2007.03261.x. PMID 17373914.

[pmid23384801-19] Schiller LR (2012). "Definitions, pathophysiology, and evaluation of chronic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 551–62. doi:10.1016/j.bpg.2012.11.011. PMID 23384801.

[pmid3523719-20] Giannella RA (1986). "Chronic diarrhea in travelers: diagnostic and therapeutic considerations". Rev. Infect. Dis. 8 Suppl 2: S223–6. PMID 3523719.

[pmid16151544-21] 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.

[pmid12135027-22] Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.

[pmid1702075-23] Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.

[pmid14439871-24] RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.

[pmid8209928-25] Konvolinka CW (1994). "Acute diverticulitis under age forty". Am J Surg. 167 (6): 562–5. PMID 8209928.

[pmid16698746-26] Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006). "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications". Gut. 55 (6): 749–53. doi:10.1136/gut.2005.082909. PMC 1856208. PMID 16698746.

[pmid12700377-27] Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003). "Amebiasis". N Engl J Med. 348 (16): 1565–73. doi:10.1056/NEJMra022710. PMID 12700377.

[pmid8694025-28] Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.

[pmid9414969-29] Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.

[pmid15391722-30] BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.

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@@ Line 16: / Line 16: @@
 {{SI}}
 ==Overview==
-'''Small bowel bacterial overgrowth syndrome''' ('''SBBOS'''), or '''small intestinal bacterial overgrowth''' ('''SIBO'''), also termed '''bacterial overgrowth'''; is a disorder of excessive bacterial growth in the [[small intestine]].  Unlike the [[colon (anatomy)|colon]] (or large bowel), which is rich with [[bacteria]], the small bowel usually has less than 10<sup>4</sup> organisms per millilitre.<!--
-    --><ref name=Quigley>{{cite journal | author = Quigley E, Quera R | title = Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. | journal = Gastroenterology | volume = 130 | issue = 2 Suppl 1 | pages = S78-90 | year = 2006 | id = PMID 16473077}}</ref>  <!--
--->Patients with bacterial overgrowth typically develop symptoms including [[nausea]], [[bloating]], [[vomiting]] and [[diarrhea]], which is caused by a number of mechanisms.  The [[diagnosis]] of bacterial overgrowth is made by a number of techniques, with the [[gold standard (test)|gold standard]] diagnosis being an [[Needle aspiration biopsy|aspirate]] from the [[jejunum]] that grows in excess of 10<sup>5</sup> [[bacteria]] per millilitre.  [[Risk factor]]s for the development of bacterial overgrowth include the use of medications including [[proton pump inhibitors]], [[anatomy|anatomical]] disturbances in the bowel, including [[fistula]]e, [[diverticula]] and blind loops created after surgery, and resection of the [[ileo-cecal valve]].  Small bowel bacterial overgrowth syndrome is treated with [[antibiotic]]s, which may be given in a cyclic fashion to prevent tolerance to the antibiotics.
-==Clinical presentation==
+==Historical Perspective==
-[[Image:Cobalmin.png|left|thumb|Deficiency of [[vitamin B12]] can occur in bacterial overgrowth]]
+*Small intestinal bacterial overgrowth (SIBO) was first discovered by  Barber and Hummel in 1939.
-Bacterial overgrowth can cause a variety of [[symptom]]s, many of which are also found in other conditions, making the [[diagnosis]] challenging at times.<!--
+*In 2000, Pimentel et all at Cedars-Sinai Medical Center were first identified that SIBO was present in 78% of patients with irritable bowel syndrome (IBS), and that treatment with antibiotics improved symptoms.
---><ref name=Quigley/><ref name=Teo>{{cite journal | author = Teo M, Chung S, Chitti L, Tran C, Kritas S, Butler R, Cummins A | title = Small bowel bacterial overgrowth is a common cause of chronic diarrhea. | journal = J Gastroenterol Hepatol | volume = 19 | issue = 8 | pages = 904-9 | year = 2004 | id = PMID 15242494}}</ref>  <!--
+*In May 2015,  U.S. Food and Drug Administration (FDA) approved rifaximin to treat SIBO.
--->Many of the symptoms are due to [[malabsorption]] of nutrients due to the effects of bacteria which either metabolize nutrients or cause inflammation of the small bowel impairing absorption.  The symptoms of bacterial overgrowth include [[nausea]], [[bloating]], [[flatus]], and [[chronic]] [[diarrhea]].  Some patients may develop abdominal discomfort and lose weight.  Children with bacterial overgrowth may develop [[malnutrition]] have difficulty attaining [[failure to thrive|proper growth]].  [[Steatorrhea]] is a sticky type of diarrhea, where [[lipid]]s are malabsorbed and spill into the stool.<!--
-  --><ref name=Kirsch>{{cite journal | author = Kirsch M | title = Bacterial overgrowth. | journal = Am J Gastroenterol | volume = 85 | issue = 3 | pages = 231-7 | year = 1990 | id = PMID 2178395}}</ref><!--
--->
-Patients with bacterial overgrowth that is longstanding can develop complications of their illness as a result of malabsorption of nutrients.  [[Anemia]] may occur from a variety of mechanisms, as many of the nutrients involved in production of [[red blood cell]]s are absorbed in the affected small bowel.  [[Iron]] is absorbed in the more proximal parts of the small bowel, the [[duodenum]] and [[jejunum]], and patients with malabsorption of iron can develop a [[microcytic anemia]], with small red blood cells.  [[Vitamin B12]] is absorbed in the last part of the small bowel, the [[ileum]], and patients who malabsorb vitamin B12 can develop a [[megaloblastic anemia]] with large red blood cells.<ref name=Kirsch/>
+==Classification==
+*There is no established system for the classification of small intestinal bacterial overgrowth(SIBO).
 ==Pathophysiology==
-[[Image:E coli at 10000x, original.jpg|left|thumb|''E. coli'', shown in this electron micrograph, is commonly isolated in patients with bacterial overgrowth]]
+*The pathogenesis of small intestinal bacterial overgrowth (SIBO) is characterized by an increased microbial load in the small intestine.
+*A healthy individual has less than 103 organisms/mL in the upper small intestine, and the majority of these organisms are gram-positive bacteria.
+*Body's homeostatic mechanisms protect against excessive small intestinal colonization by bacteria include :
+**Gastric acid and bile eradicate micro-organisms before they leave the stomach
+**Migrating motor complex clears the excess unwanted bacteria of upper intestine
+**Intestinal mucosa serves as a protective layer for the gut wall.
+**Normal intestinal flora (eg, Lactobacillus) maintains a low pH that prevents bacterial overgrowth.
+**Physical barrier of the ileocecal valve that prevents retrograde translocation of bacteria from colon to the small intestine.
+*Disruption of these protective homeostatic mechanisms can increase the risk of SIBO.
+*Bacterial colonization causes an inflammatory response in the intestinal mucosa.
+*Damage to the intestinal mucosa leads to malabsorption of bile acids, carbohydrates, proteins and vitamins resulting in symptoms of diarrhea and weightloss.
+*On gross pathology, mucosal edema, loss of normal vascular pattern, patchy erythema, friability and ulceration of the small intestinal wall is associated with small intestinal bacterial overgrowth (SIBO).
+*On microscopic histopathological analysis small intestine and colon is normal in most patients with SIBO. Findings include:
+**Blunting of the intestinal villi
+**Thinning of the mucosa and crypts
+**Increased intraepithelial lymphocytes==Causes==
+*Small intestinal bacterial overgrowth (SIBO) may be caused by disruption of the protective homeostatic mechanisms that control enteric bacteria population.
+*Causes of small intestinal bacterial overgrowth (SIBO) include:
+**Irregular small intestinal motility
+***Diabetic autonomic neuropathy
+***Scleroderma
+***Pseudo-obstruction
+***Amyloidosis
+***Neurological diseases (eg, myotonic dystrophy, Parkinson disease)
+***Radiation enteritis
+***Crohn disease
+***Hypothyroidism
+**Blind pouches in the gastrointestinal tract
+***Side-to-side or end-to-side anastomoses
+***Duodenal or jejunal diverticula
+***Segmental dilatation of the ileum
+***Blind loop syndrome
+***Biliopancreatic diversion
+***Chagasic megacolon
+**Fistula
+***Gastrocolic fistulae
+***Jejunal-colic fistulae
+**Partial Obstruction
+***Strictures
+***Adhesions
+***Abdominal masses
+***Leiomyosarcoma
+**Decreased gastric acid secretion
+***Achlorhydria
+***Vagotomy
+***Long-term proton pump inhibitor therapy
-Certain species of bacteria are more commonly found in aspirates of the [[jejunum]] taken from patients with bacterial overgrowth.  The most common isolates are ''[[Escherichia coli]]'', ''[[Streptococcus]]'', ''[[Lactobacillus]]'', ''[[Bacteroides]]'', and ''[[Enterococcus]]'' species.<!--
+==Differentiating [disease name] from other Diseases==
-   --><ref name=Bouhnik>{{cite journal | author = Bouhnik Y, Alain S, Attar A, Flourié B, Raskine L, Sanson-Le Pors M, Rambaud J | title = Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome. | journal = Am J Gastroenterol | volume = 94 | issue = 5 | pages = 1327-31 | year = 1999 | id = PMID 10235214}}</ref>  <!--
+*Small intestinal bacterial overgrowth (SIBO) must be differentiated from other diseases that cause chronic diarrhea.
--->
+'''The following table outlines the major differential diagnoses of chronic diarrhea.'''<ref name="Casburn-JonesFarthing2004">{{cite journal|last1=Casburn-Jones|first1=Anna C|last2=Farthing|first2=Michael Jg|title=Traveler's diarrhea|journal=Journal of Gastroenterology and Hepatology|volume=19|issue=6|year=2004|pages=610–618|issn=0815-9319|doi=10.1111/j.1440-1746.2003.03287.x}}</ref><ref name="KamatMathur2006">{{cite journal|last1=Kamat|first1=Deepak|last2=Mathur|first2=Ambika|title=Prevention and Management of Travelers’ Diarrhea|journal=Disease-a-Month|volume=52|issue=7|year=2006|pages=289–302|issn=00115029|doi=10.1016/j.disamonth.2006.08.003}}</ref><ref name="PfeifferDuPont2012">{{cite journal|last1=Pfeiffer|first1=Margaret L.|last2=DuPont|first2=Herbert L.|last3=Ochoa|first3=Theresa J.|title=The patient presenting with acute dysentery – A systematic review|journal=Journal of Infection|volume=64|issue=4|year=2012|pages=374–386|issn=01634453|doi=10.1016/j.jinf.2012.01.006}}</ref><ref name="pmid24506120">{{cite journal |vauthors=Barr W, Smith A |title=Acute diarrhea |journal=Am Fam Physician |volume=89 |issue=3 |pages=180–9 |year=2014 |pmid=24506120 |doi= |url=}}</ref><ref name="pmid29255768">{{cite journal |vauthors=Amil Dias J |title=Celiac Disease: What Do We Know in 2017? |journal=GE Port J Gastroenterol |volume=24 |issue=6 |pages=275–278 |year=2017 |pmid=29255768 |doi=10.1159/000479881 |url=}}</ref><ref name="pmid29254859">{{cite journal |vauthors=Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi AKM |title=Shigellosis |journal=Lancet |volume= |issue= |pages= |year=2017 |pmid=29254859 |doi=10.1016/S0140-6736(17)33296-8 |url=}}</ref><ref name="Yamamoto-FurushoBosques-Padilla2017">{{cite journal|last1=Yamamoto-Furusho|first1=J.K.|last2=Bosques-Padilla|first2=F.|last3=de-Paula|first3=J.|last4=Galiano|first4=M.T.|last5=Ibañez|first5=P.|last6=Juliao|first6=F.|last7=Kotze|first7=P.G.|last8=Rocha|first8=J.L.|last9=Steinwurz|first9=F.|last10=Veitia|first10=G.|last11=Zaltman|first11=C.|title=Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation|journal=Revista de Gastroenterología de México|volume=82|issue=1|year=2017|pages=46–84|issn=03750906|doi=10.1016/j.rgmx.2016.07.003}}</ref><ref name="BorbélyOsterwalder2017">{{cite journal|last1=Borbély|first1=Yves M|last2=Osterwalder|first2=Alice|last3=Kröll|first3=Dino|last4=Nett|first4=Philipp C|last5=Inglin|first5=Roman A|title=Diarrhea after bariatric procedures: Diagnosis and therapy|journal=World Journal of Gastroenterology|volume=23|issue=26|year=2017|pages=4689|issn=1007-9327|doi=10.3748/wjg.v23.i26.4689}}</ref><ref name="CrawfordRamani2017">{{cite journal|last1=Crawford|first1=Sue E.|last2=Ramani|first2=Sasirekha|last3=Tate|first3=Jacqueline E.|last4=Parashar|first4=Umesh D.|last5=Svensson|first5=Lennart|last6=Hagbom|first6=Marie|last7=Franco|first7=Manuel A.|last8=Greenberg|first8=Harry B.|last9=O'Ryan|first9=Miguel|last10=Kang|first10=Gagandeep|last11=Desselberger|first11=Ulrich|last12=Estes|first12=Mary K.|title=Rotavirus infection|journal=Nature Reviews Disease Primers|volume=3|year=2017|pages=17083|issn=2056-676X|doi=10.1038/nrdp.2017.83}}</ref><ref name="pmid11068510">{{cite journal |vauthors=Kist M |title=[Chronic diarrhea: value of microbiology in diagnosis] |language=German |journal=Praxis (Bern 1994) |volume=89 |issue=39 |pages=1559–65 |year=2000 |pmid=11068510 |doi= |url=}}</ref><ref name="pmid4014291">{{cite journal |vauthors=Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH |title=Evaluation and diagnosis of acute infectious diarrhea |journal=Am. J. Med. |volume=78 |issue=6B |pages=91–8 |year=1985 |pmid=4014291 |doi= |url=}}</ref><ref name="pmid10575169">{{cite journal |vauthors=López-Vélez R, Turrientes MC, Garrón C, Montilla P, Navajas R, Fenoy S, del Aguila C |title=Microsporidiosis in travelers with diarrhea from the tropics |journal=J Travel Med |volume=6 |issue=4 |pages=223–7 |year=1999 |pmid=10575169 |doi= |url=}}</ref><ref name="WahnschaffeIgnatius2009">{{cite journal|last1=Wahnschaffe|first1=Ulrich|last2=Ignatius|first2=Ralf|last3=Loddenkemper|first3=Christoph|last4=Liesenfeld|first4=Oliver|last5=Muehlen|first5=Marion|last6=Jelinek|first6=Thomas|last7=Burchard|first7=Gerd Dieter|last8=Weinke|first8=Thomas|last9=Harms|first9=Gundel|last10=Stein|first10=Harald|last11=Zeitz|first11=Martin|last12=Ullrich|first12=Reiner|last13=Schneider|first13=Thomas|title=Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas|journal=Scandinavian Journal of Gastroenterology|volume=42|issue=3|year=2009|pages=391–396|issn=0036-5521|doi=10.1080/00365520600881193}}</ref><ref name="pmid27765536">{{cite journal |vauthors=Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA |title=75SeHCAT scan in bile acid malabsorption in chronic diarrhoea |journal=Rev Esp Med Nucl Imagen Mol |volume=36 |issue=1 |pages=37–47 |year=2017 |pmid=27765536 |doi=10.1016/j.remn.2016.08.005 |url=}}</ref><ref name="pmid19365159">{{cite journal |vauthors=Gibson RJ, Stringer AM |title=Chemotherapy-induced diarrhoea |journal=Curr Opin Support Palliat Care |volume=3 |issue=1 |pages=31–5 |year=2009 |pmid=19365159 |doi=10.1097/SPC.0b013e32832531bb |url=}}</ref><ref name="pmid23384808">{{cite journal |vauthors=Abraham BP, Sellin JH |title=Drug-induced, factitious, & idiopathic diarrhoea |journal=Best Pract Res Clin Gastroenterol |volume=26 |issue=5 |pages=633–48 |year=2012 |pmid=23384808 |doi=10.1016/j.bpg.2012.11.007 |url=}}</ref><ref name="pmid25692805">{{cite journal |vauthors=Reintam Blaser A, Deane AM, Fruhwald S |title=Diarrhoea in the critically ill |journal=Curr Opin Crit Care |volume=21 |issue=2 |pages=142–53 |year=2015 |pmid=25692805 |doi=10.1097/MCC.0000000000000188 |url=}}</ref><ref name="pmid17373914">{{cite journal |vauthors=McMahan ZH, DuPont HL |title=Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy |journal=Aliment. 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-Soon after birth, the [[gastrointestinal tract]] is colonized with bacteria, which, on the basis of models with animals raised in a germ-free environment, have beneficial effects on function of the gastrointestinal tract.  There are 500-1000 different species of bacteria that reside in the bowel.<!--
+<span style="font-size:85%">'''Abbreviations:''' '''GI:''' [[Gastrointestinal tract|Gastrointestinal]], '''CBC''': [[Complete blood count]], '''WBC:''' [[White blood cells|White blood cell]], '''RBC''': [[Red blood cell]], '''Plt:''' [[Platelet]], '''Hgb:''' [[Hemoglobin]], '''ESR''': [[Erythrocyte sedimentation rate]], '''CRP''': [[C-reactive protein|C–reactive protein]], '''IgE:''' [[Immunoglobulin E]], '''IgA:''' [[Immunoglobulin A]], '''ETEC:''' [[Escherichia coli enteritis]], '''EPEC''': [[Escherichia coli|Enteropathogenic Escherichia coli]], '''EIEC''': [[Escherichia coli enteritis|Enteroinvasive Escherichia coli]], '''EHEC''': [[Escherichia coli|Enterohemorrhagic Escherichia coli]], '''EAEC''': [[Escherichia coli enteritis|Enteroaggregative Escherichia coli]], '''Nl''': Normal, '''ASCA''': [[Anti saccharomyces cerevisiae antibodies]], '''ANCA''': [[Anti-neutrophil cytoplasmic antibody|Anti–neutrophil cytoplasmic antibody]], '''DNA''': [[DNA|Deoxyribonucleic acid]], '''CFTR''': [[Cystic fibrosis transmembrane conductance regulator]], '''SLC10A2''': [[SLC10A2|Solute carrier family 10 member 2]], '''SeHCAT''': [[SeHCAT|Selenium homocholic acid taurine or tauroselcholic acid]], '''IEL''': Intraepithelial [[Lymphocyte|lymphocytes]], '''MRCP''': [[Magnetic resonance cholangiopancreatography]], '''ANA''': [[Antinuclear antibodies]], '''AMA''': [[Anti-mitochondrial antibody]], '''LDH''': [[Lactate dehydrogenase]], '''CPK''': [[Creatine phosphokinase]], '''PCR''': [[Polymerase chain reaction]], '''ELISA''': [[Enzyme linked immunosorbent assay (ELISA)|Enzyme–linked immunosorbent assay]], '''LT''': Heat–labile [[enterotoxin]], ST: Heat–stable [[enterotoxin]], '''RT-PCR''': Reverse–transcriptase [[polymerase chain reaction]], '''CD4:''' [[CD4|Cluster of differentiation 4]], '''HIV''': [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]], '''RUQ''': [[RUQ|Right-upper quadrant]], '''VIP''': [[Vasoactive intestinal peptide]], '''GI:''' [[Gastrointestinal tract|Gastrointestinal]], '''FAP''': [[Familial adenomatous polyposis]], '''HNPCC''': [[Hereditary nonpolyposis colorectal cancer]], '''MTP''': [[Microsomal triglyceride transfer protein]], '''Scl‑70''': Anti–[[Type I topoisomerase|topoisomerase I]], '''TSH''': [[Thyroid-stimulating hormone]], '''T4''': [[Thyroxine]], '''T3''': [[Triiodothyronine]], '''DTR''': [[Deep tendon reflex]], '''RNA''': [[RNA|Ribonucleic acid]]</span>
-   --><ref name=Germ>{{cite journal | author = Hao W, Lee Y | title = Microflora of the gastrointestinal tract: a review. | journal = Methods Mol Biol | volume = 268 | issue = | pages = 491-502 | year = | id = PMID 15156063}}</ref>  <!--
--->However, if the flora of the small bowel is altered, inflammation or altered digestion can occur, leading to symptoms.  Many patients with chronic diarrhea have bacterial overgrowth as a cause or a contributor to their symptoms.<ref name=Teo/>  While the consensus definition of chronic diarrhea varies, in general it is considered to be an alteration in stool consistency or increased frequency, that occurs for over three weeks.  Various mechanisms are involved in the development of diarrhea in bacterial overgrowth.  First, the excessive bacterial concentrations can cause direct inflammation of the small bowel cells, leading to an ''inflammatory'' diarrhea.  The malabsorption of [[lipid]]s, [[protein]]s and [[carbohydrate]]s may cause poorly digestible products to enter into the [[colon (anatomy)|colon]].  This can cause diarrhea by the [[osmosis|osmotic drive]] of these molecules, but can also stimulate the secretory mechanisms of colonic cells, leading to a ''secretory diarrhea''.<ref name=Kirsch/>
-==Risk factors and causes==
+{| class="wikitable" style="border: 0px; font-size: 100%; margin: 3px;" align="center"
-[[Image:Ileocecal valve.jpg|thumb|left|The [[ileo-cecal valve]] prevents reflux of bacteria from the colon into the small bowel.  Resection of the valve can lead to bacterial overgrowth]]
+! colspan="2" rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+| colspan="9" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestation'''
+! colspan="9" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Lab findings'''
+! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" |Symptoms
+! rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+|-
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+| colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |'''CBC'''
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Crohns disease|Crohn's disease]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Abdominal tenderness]]
+* Oral [[mucosal]] lesions
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Anti saccharomyces cerevisiae antibodies]] (ASCA)
+* [[Vitamin B12]] deficiency
+* Elevated [[erythrocyte sedimentation rate|ESR]]
+* Elevated [[C-reactive protein|CRP]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Uveitis]]
+* [[Arthritis]]
+* [[Erythema nodosum]]
+* [[Pyoderma gangrenosum]]
+* [[Amyloidosis]]
+* Venous and arterial [[thromboembolism]]
+* [[Kidney stone|Renal stones]]
+* [[Bronchiectasis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Abnormal immune response to self [[antigens]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Colonoscopy]] with [[biopsy]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Ulcerative colitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Abdominal tenderness]]
+* [[Blood]] on [[rectal examination]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Anti-neutrophil cytoplasmic antibody|Anti–neutrophil cytoplasmic antibody]] ([[P-ANCA|P–ANCA]])
+* [[Hypoalbuminemia]]
+* [[Hypokalemia]]
+* [[Hypomagnesemia]]
+* Elevated [[Erythrocyte sedimentation rate|ESR]]
+* Elevated [[C-reactive protein|CRP]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Skin rash]]
+* [[Iritis]]
+* [[Uveitis]]
+* Seronegative [[arthritis]]
+* [[Clubbing]]
+* [[Erythema nodosum]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Abnormal immune response to self [[antigens]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Colonoscopy]] with [[biopsy]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Celiac disease]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Abdominal distention]]
+* Increased [[bowel]] sounds
+* Oral [[Mucous membrane|mucosal]] lesions
+* [[Hepatosplenomegaly]]
+* [[Ascites]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Fat droplets on [[sudan stain]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[IgA]] endomysial [[antibody]]
+* Anti–tissue [[transglutaminase]] [[antibody]]
+* [[Anti-gliadin antibodies|Anti–gliadin antibody]]
+* [[Fat soluble vitamins]] deficiency
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Malabsorption]]
+* [[Dementia]]
+* [[Dermatitis herpetiformis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[HLA-DQ2|HLA–DQ2]]
+* [[HLA-DQ8|HLA–DQ8]]
+* Innate responses to wheat [[Protein|proteins]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[IgA]] endomysial [[antibody]]
+* Anti–tissue [[transglutaminase]] [[antibody]]
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Cystic fibrosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Abdominal distension|Abdominal distention]]
+*[[Hepatosplenomegaly]]
+*[[Rectal prolapse]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Fat droplets on [[sudan stain]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Positive [[DNA]] analysis for [[CFTR|cystic fibrosis transmembrane conductance regulator]] [[CFTR|(CFTR)]]
+* Nasal transepithelial potential difference
+* [[Fat soluble vitamins]] deficiency
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Malabsorption]]
+* Recurrent [[respiratory tract infection]]
+* [[Bronchiectasis]]
+* [[Diabetes mellitus]]
+* [[Scoliosis]]
+* [[Infertility]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Mutations in the [[cystic fibrosis transmembrane conductance regulator]] ([[CFTR]]) protein
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Positive [[genetic testing]]
+* Elevated [[Sweat chloride test|sweat chloride]] ≥60 mmol/L
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Chronic pancreatitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Tenderness (medicine)|Abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Fat droplets on [[sudan stain]]
+* Positive [[fecal elastase]] measurement
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Slightly elevated [[amylase]] and [[lipase]]
+* Abnormal pancreatic function test
+* [[Secretin]] stimulation test
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Malabsorption]]
+* [[Diabetes mellitus]]
+* [[Pancreatic pseudocyst]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Toxin|Toxins]]
+* Recurrent [[acute pancreatitis]]
+* [[Genetics|Genetic]] predesposition
+* [[Autoimmunity|Autoimmune]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Magnetic resonance cholangiopancreatography]] ([[Magnetic resonance cholangiopancreatography|MRCP]])
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Bile acid malabsorption]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Fat droplets on [[sudan stain]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Reduced [[cholesterol]] level
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malabsorption]]
+*[[Hypotension]]
+*[[Tachycardia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Genetic defects in ''[[SLC10A2]]''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[SeHCAT]] test
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Microscopic colitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Abdominal tenderness]]
+* Fecal [[incontinence]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Hypokalemia]]
+* Elevated [[C-reactive protein|CRP]]
+* Positive [[autoantibodies]] include:
+**RF
+**[[ANA]]
+**[[Anti-mitochondrial antibody|AMA]]
+**[[ANCA]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Arthritis]]
+* [[Uveitis]]
+* [[Idiopathic thrombocytopenic purpura]]
+* Pleuro [[pericarditis]]
+* [[Hypothyroidism]]
+* [[Psoriasis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Mucosal]] [[immune responses]] to luminal factors in a genetically predisposed individual
+* Drug–induced
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Colonoscopy]] with [[mucosal]] [[biopsy]] with [[mononuclear]] infiltrates:
+** [[Collagenous colitis]] is characterized by a colonic subepithelial [[collagen]] band >10 micrometers in diameter
+** [[Lymphocytic]] [[colitis]] is characterized by ≥20 intraepithelial [[lymphocytes]] (IEL) per 100 surface epithelial cells
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Infective colitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Rebound [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+*Positive fecal calprotectin
+*Positive fecal [[lactoferrin]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated [[C-reactive protein|CRP]]
+*Elevated [[Erythrocyte sedimentation rate|ESR]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Arthritis]]
+* [[Uveitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Salmonella|''Salmonella'']]
+*[[Shigella|''Shigella'']]
+*[[Campylobacter|''Campylobacter'']]
+*''[[Escherichia coli|E. coli 0157:H7]]''
+*[[Clostridium difficile|''Clostridium difficile'']]
+*[[Entamoeba histolytica|''Entamoeba histolytica'']]
+*[[Adenoviridae|''Adenovirus'']]
+*[[Cytomegalovirus|''Cytomegalovirus'']]
+*[[Herpes simplex virus|''Herpes simplex virus'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Stool culture]]
+*[[Blood culture]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Ischemic colitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Hyperactive then absent [[Stomach rumble|bowel sounds]]
+*[[Tenderness (medicine)|Abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated [[C-reactive protein|CRP]]
+*Elevated [[Erythrocyte sedimentation rate|ESR]]
+*Elevated serum [[Lactic acid|lactate]]
+*Elevated [[lactate dehydrogenase]] ([[Lactate dehydrogenase|LDH]])
+*Elevated [[Creatine kinase|creatine phosphokinase]] ([[Creatine kinase|CPK]])
+*Elevated [[amylase]]
+*[[Hypoalbuminemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Henoch-Schönlein purpura|IgA vasculitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Thrombophilia|Hypercoagulability]]
+*Nonocclusive [[Ischemic colitis|colonic ischemia]]
+*[[Embolism|Embolic]] and [[Thrombosis|thrombotic]] arterial occlusion
+*[[Mesenteric vein thrombosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Abdominal [[Computed tomography|CT scan]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Lactose intolerance]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Abdominal tenderness ]]
+* [[Abdominal distention]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Lactose tolerance test
+* Genetic testing
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Headache]]
+* [[Vertigo]]
+* [[Memory impairment]]
+* [[Lethargy]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Reduction of lactase enzyme activity or inability to produce persistent [[lactase]]
+* Congenital [[lactase deficiency]]
+* Secondary lactose malabsorption
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Small bowel]] [[biopsy]]
+* Lactose breath hydrogen test
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Irritable bowel syndrome]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Abdominal tenderness]]
+* [[Abdominal distention]]
+* Normal [[Stomach rumble|bowel sounds]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Anxiety]]
+*[[Palpitation]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Unknown
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Diagnosis of exclusion
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Whipple's disease]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Hepatosplenomegaly]]
+* [[Ascites]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓/↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Hypoalbuminemia]]
+*[[Fat soluble vitamins]] deficiency
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Malabsorption]]
+* [[Ocular motility disorders|Abnormal extraocular movement]]
+* [[Lymphadenopathy]]
+* [[Hyperpigmentation]]
+* [[Uveitis]]
+* [[Endocarditis]]
+* [[Encephalitis]]
+* [[Dementia]]
+* [[Pleural effusion]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Tropheryma whipplei|''Tropheryma whipplei'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Small intestine]] [[biopsy]] for [[Tropheryma whipplei]] testing
+* [[PCR]] testing
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Tropical sprue]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Angular [[stomatitis]]
+* Oral mucosal lesion
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Fat soluble vitamins]] deficiency
+* [[Vitamin B12 deficiency]]
+* [[Folate deficiency]]
+* [[Hypokalemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Myalgia]]
+*[[Neuropathy]]
+*[[Edema]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* ''[[Escherichia coli]]''
+* ''[[Klebsiella pneumoniae]]''
+* ''[[Enterobacter cloacae]]''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Diagnosis of exclusion
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Small bowel bacterial overgrowth syndrome|Small bowel bacterial overgrowth]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Abdominal distension|Abdominal distention]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Hypoalbuminemia]]
+* Abnormal [[Hydrogen Breath Test|hydrogen breath test]]
+* [[Lactic acidosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Malabsorption]]
+* [[Rosacea]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Excess bacteria in the [[small intestine]]
+* Alterations in [[Intestine|intestinal]] [[anatomy]] or GI motility
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Diagnosis of exclusion
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Salmonellosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distention]]
+*Diffuse [[abdominal tenderness]]
+*[[Hepatosplenomegaly]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+*Positive serologic testing
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Hypokalemia]]
+*[[Hypernatremia]]
+*[[Hyponatremia]]
+* [[Hypercalciuria]]
+* [[Hypocitraturia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Post-infectious arthritis|Post–infectious arthritis]]
+* [[Obtundation]]
+* [[Bacteremia]]
+* [[Pericarditis]]
+* [[Pyelonephritis]]
+*[[Brain abscess]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Salmonella|''Salmonella'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Stool culture]]
+|-
+! rowspan="2" style="background:#DCDCDC;" align="center" |[[Escherichia coli enteritis]]
+| style="background:#DCDCDC;" align="center" |[[EPEC|'''EPEC''']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Diffuse [[abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*''[[Enteropathogenic E. coli]]''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Hybridization probe|DNA probe]] or [[polymerase chain reaction]] ([[Polymerase chain reaction|PCR]]) of the ''EPEC'' adherence factor
+*[[Stool culture]]
+|-
+| style="background:#DCDCDC;" align="center" |[[EAEC|'''EAEC''']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Diffuse [[abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Chronic infection in [[Immunodeficiency|immunocompromised]] patients
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Escherichia coli enteritis|''Enteroaggregative E. coli'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Stool culture]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Aeromonas]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+* [[Abdominal distention]]
+* Hyperactive [[Stomach rumble|bowel sounds]]
+* Diffuse [[abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[stool culture]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Wound [[infection]]
+*[[Bacteremia]]
+*[[Hemolytic-uremic syndrome|Hemolytic uremic syndrome]]
+*[[Meningitis]]
+*[[Ocular]] infection
+*[[Pneumonia]]
+*[[Urinary tract infection]]
+*[[Osteomyelitis]]
+*[[Peritonitis]]
+*[[Acute cholecystitis]]
+*[[Opportunistic infection|Opportunistic infections]] in [[Immunodeficiency|immunocompromised]] patients
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*''[[Aeromonas]]'' virulence factors including [[Endotoxin|endotoxins]], [[Hemolysin|hemolysins]], [[Enterotoxin|enterotoxins]], and adherence factors
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Blood culture]]
+*Wound [[Culture collection|culture]]
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Mycobacterium avium complex]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Abdominal distension|Abdominal distention]]
+*[[Hepatosplenomegaly]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated [[Liver function tests|liver enzymes]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Opportunistic infection]] in [[Immunodeficiency|immunocompromised]] patients
+*[[Pulmonary]] [[infection]]
+*[[Lymphadenopathy|Adenopathy]]
+*[[Sleep hyperhidrosis|Night sweats]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Mycobacterium avium complex|''Mycobacterium avium complex'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Blood culture]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[CMV colitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Viral antigen assay
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Decreased [[CD4]] level
+*Abnormal [[Liver function tests|liver function test]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Encephalitis]]
+*[[Guillain-Barré syndrome|Guillain–Barré syndrome]]
+*[[Pneumonia]]
+*[[Retinitis]]
+*[[Pericarditis]] and [[myocarditis]]
+*[[Atherosclerosis]]
+*[[Venous thromboembolism|Venous thrombosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Cytomegalovirus|''Cytomegalovirus'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Quantitative polymerase chain reaction|Quantitative PCR]] tests
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Human Immunodeficiency Virus (HIV)|HIV]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distension|Abdominal distention]]
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Decreased [[CD4]] level
+*[[Electrolyte disturbance|Electrolyte imbalance]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Lymphadenopathy]]
+*Disseminated [[infection]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Human Immunodeficiency Virus (HIV)|''HIV'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*HIV virologic (viral load) test
+*Immunoassay
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Entamoeba histolytica]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distension|Abdominal distention]]
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Liver abscess]]
+*Pleuropulmonary infection
+*[[Cardiac]] [[infection]]
+*[[Brain abscess]]
+*[[Skin and soft-tissue infections|Cutaneous infection]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Entamoeba histolytica|''Entamoeba histolytica'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Antigen testing
+*Serology
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Giardia lamblia|Giardia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distension|Abdominal distention]]
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malabsorption]]
+*[[Urticaria]]
+*[[Depression]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*''[[Giardia lamblia]]''
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Antigen detection assays
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Cryptosporidium]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distension|Abdominal distention]]
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive stool microscopy
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated [[alkaline phosphatase]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Chronic, life–threatening illness in [[Immunodeficiency|immunocompromised]] patients
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Cryptosporidium|''Cryptosporidium'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Polymerase chain reaction
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Microsporidia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distension|Abdominal distention]]
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive stool microscopy
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Decreased [[CD4]] count
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malabsorption]]
+*[[Keratitis]]
+*[[Seizure]]
+*[[Myositis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Microsporidia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Antigen detection assays
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Isospora]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Abdominal distension|Abdominal distention]]
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive stool microscopy
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated [[Eosinophil granulocyte|eosinophils]]
+*[[Hypokalemia]]
+*Increased [[creatinine]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Chronic illness in [[Immunodeficiency|immunocompromised]] patients
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Isospora|''Isospora'']]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Detecting oocysts in the feces
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Carcinoid syndrome|Carcinoid tumor]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+* [[Abdominal distention]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated urinary [[5-Hydroxyindoleacetic acid|5–hydroxyindoleacetic acid]] ([[5-Hydroxyindoleacetic acid|5–HIAA]]) level
+*High [[chromogranin A]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Flushing|Facial flushing]]
+*[[Jaundice]]
+*[[Edema]]
+*[[Valvular heart disease]]
+*[[Congestive heart failure|Right–sided heart failure]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Well–differentiated [[Neuroendocrine tumors|neuroendocrine tumor]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Blood [[chromogranin A]]  level
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[VIPoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+* [[Abdominal distention]]
+* Abdominal [[RUQ]] [[tenderness]]
+* [[Nausea]]
+* [[Vomiting]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated [[VIP]] level
+*[[Hypokalemia]]
+*[[Hypochlorhydria]] or [[achlorhydria]]
+*Low osmotic gap (<50 mOsm/kg)
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Rash]]
+* [[Facial flushing]]
+* [[Dehydration]]
+* [[Lethargy]]
+* [[Muscle weakness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Primary secretory tumor
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Blood [[VIP]] levels
+* Followed by imaging
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Zollinger-Ellison syndrome|Zollinger–Ellison syndrome]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+** [[Tenderness|Epigastric tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Positive [[secretin]] stimulation test
+* Elevated serum [[chromogranin A]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+** [[Jaundice]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Gastrin]] producing [[tumor]] mainly in [[duodenum]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Secretin]] stimulation test
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Neuroendocrine tumors|Somatostatinoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+** [[Tenderness|Epigastric tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated fasting plasma [[somatostatin]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+** [[Diabetes mellitus]]
+** [[Gallstone disease|Cholelithiasis]]
+** [[Jaundice]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Neuroendocrine tumors]] of D–cell origin
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Plasma [[somatostatin]] level
+*Followed by imaging
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Lymphoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+*[[Hepatosplenomegaly]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Paraproteinemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Malabsorption]]
+* [[Lactose intolerance]]
+* [[Ascites]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Primary [[tumor]] of GI tract
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Colonoscopy]] with [[biopsy]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Colorectal cancer]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Positive [[carcinoembryonic antigen]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Metastasis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[FAP|FAP gene]]
+*[[Hereditary nonpolyposis colorectal cancer|HNPCC gene]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+** [[Colonoscopy]] and [[biopsy]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |Medications
+* [[ACE inhibitor|ACE inhibitors]]
+* [[Digoxin]]
+* [[Cephalosporin|Cephalosporins]]
+* [[Statins]]
+* [[Thiazide|Thiazide diuretics]]
+* [[Triptans]]
+* [[Lactulose]]
+* [[HIV AIDS medical therapy|Anti retroviral agents]]
+* [[Chemotherapy|Chemotherapeutic agents]]
+* [[Antifungal drug|Antifungals]]
+* [[Magnesium]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distention]]
+*[[Dehydration]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated plasma level of drug
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Inflammation]]
+*[[Pseudomembranous enterocolitis|Pseudomembranous colitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical evaluation after discontinuation of the drugs
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |Factitious diarrhea
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distention]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Hypokalemia]]
+*[[Metabolic alkalosis]]
+*[[Hypermagnesemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malabsorption]]
+*[[Lethargy]]
+*[[Generalized weakness]]
+*[[Acute kidney injury|Acute renal failure]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Medication|Medications]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical evaluation after discontinuation of the drugs
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Heavy metal ingestion]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal distention]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Elevated plasma heavy metal level
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Headache]]
+*[[Paresthesia|Numbness]]
+*[[Alopecia]]
+*[[Vertigo]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Heavy metal ingestion]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Plasma level of heavy metal
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Organophosphate poisoning]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Saliva|Salivation]]
+*[[Nausea and vomiting|Vomiting]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Reduced RBC acetylcholinesterase
+*Plasma [[cholinesterase]] activity
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Dysautonomia|Autonomic dysfunction]]
+*Motor deficit
+*Sensory deficit
+*[[Bronchospasm]]
+*[[Urination]]
+*[[Miosis]]
+*[[Bradycardia]]
+*[[Lacrimation]]
+*[[Sweating]]
+*[[Cardiac arrhythmia|Cardiac arrhythmias]]
+*[[Acute kidney injury|Acute renal injury]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Neurotoxin|Neurotoxins]] bind to [[ACHE|acetylcholinesterase]] (AChE)
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical diagnosis
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Opium withdrawal]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Hyperactive [[Stomach rumble|bowel sounds]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Azotemia]]
+*[[Hypokalemia]]
+*[[Metabolic alkalosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Dysphoria]]
+*[[Agitation (emotion)|Restlessness]]
+*[[Perspiration|Sweating]]
+*[[Rhinorrhea]]
+*[[Tears|Lacrimation]]
+*[[Myalgia]]
+*[[Arthralgia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Opium|Opium withdrawal]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical diagnosis following [[opium withdrawal]]
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Short bowel syndrome]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Abdominal distension|Abdominal distention]]
+* [[Tenderness (medicine)|Abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Hypoalbuminemia]]
+* High level of [[Acute phase protein|acute phase reactant]]
+* Abnormal [[liver function tests]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Prior [[Intestine|intestinal]] surgery
+* [[Malabsorption]]
+* [[Crohn's disease]]
+* [[Cancer|Malignancy]]
+* Peripheral [[edema]]
+* [[Muscle atrophy]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Surgical [[bowel resection]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical diagnosis following [[bowel resection]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Radiation enteropathy|Radiation enteritis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+* [[Tenderness (medicine)|Abdominal tenderness]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Vitamin B12 deficiency
+*[[Hypoalbuminemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Prior history of [[Cancer|malignancy]] and [[radiation therapy]]
+*[[Malabsorption]]
+*[[Telangiectasia|Telangiectasias]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Radiation therapy|Radiation]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Segmental bowel [[inflammation]] on [[endoscopy]] or [[colonoscopy]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Gastric dumping syndrome|Dumping syndrome]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*Hyperactive [[bowel sound]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Hypoglycemia]]
+* [[Hydrogen Breath Test|Hydrogen breath test]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malnutrition]]
+*[[Fat soluble vitamins|Fat soluble vitamin]] deficiency
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Post operative complications|Postgastrectomy]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical diagnosis following [[gastrectomy]]
+|-
+! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
+! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
+! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
+|-
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
+! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
+! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Abetalipoproteinemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Abdominal distension]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Low [[triglyceride]]
+* Low total [[cholesterol]] levels
+* [[Acanthocytes]]
+* Low [[vitamin E]] levels
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Ataxia]]
+* [[Visual field defect]]
+* [[Dysarthria]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Autosomal recessive]] disorder caused by mutations encoding the [[microsomal triglyceride transfer protein]] (MTP)
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Clinical findings and low [[triglyceride]] and [[cholesterol]] level
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Hyperthyroidism]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Elevated [[T4]]
+* Elevated [[T3]]
+* Decreased [[TSH]]
+* High serum [[alkaline phosphatase]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Lump in the neck
+* Lid lag
+* [[Malabsorption]]
+* [[Sweating]]
+* [[Hyperpigmentation]]
+* [[Proptosis]]
+* [[Tremor]]
+* Increased [[Deep tendon reflex|DTR]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[Graves' disease]]
+* [[Hashimoto's thyroiditis]]
+* [[Toxic adenoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* [[TSH]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Diabetic neuropathy]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Fecal incontinence]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Hyperglycemia]]
+*[[Azotemia]]
+*[[Hypokalemia]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malabsorption]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Unclear
+*Disordered [[motility]]
+*Increased [[Intestine|intestinal]] secretion
+*[[Small intestinal bacterial overgrowth]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical diagnosis in a patient with long lasting [[diabetes mellitus]]
+|-
+! colspan="2" style="background:#DCDCDC;" align="center" |[[Scleroderma|Systemic sclerosis]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |±
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
+*[[Abdominal pain|Epigastric tenderness]]
+*[[Fecal incontinence]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Positive [[fecal fat]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+* Anti–[[Type I topoisomerase|topoisomerase I]] (Scl‑70) antibodies
+* [[Antinuclear antibodies]] ([[Antinuclear antibodies|ANA]])
+* [[Anti-centromere antibodies|Anti–centromere antibodies]]
+* Anti–[[RNA polymerase III]] antibody
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Malabsorption]]
+*[[Skin changes]]
+*[[Raynaud's phenomenon|Raynaud phenomenon]]
+*[[Pulmonary hypertension]]
+*[[Arthritis]]
+*[[Telangiectasia]]
+*[[Chronic renal failure]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*[[Autoimmunity|Autoimmune reaction]]
+| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
+*Clinical diagnosis
+*Followed by serologic tests
+|- }
+|}
-Certain patients are more predisposed to the development of bacterial overgrowth because of certain risk factors.  These factors can be grouped into three categories: (1) disordered [[motility]] or movement of the small bowel or anatomical changes that lead to [[stasis]], (2) disorders in the [[immune system]] and (3) conditions that cause more bacteria from the [[colon (anatomy)|colon]] to enter the [[small bowel]].<ref name=Quigley/>
-Problems with motility may either be diffuse, or localized to particular areas.  Diseases like [[scleroderma]]<!--
-    --><ref name=Scleroreview>{{cite journal | author = Rose S, Young M, Reynolds J | title = Gastrointestinal manifestations of scleroderma. | journal = Gastroenterol Clin North Am | volume = 27 | issue = 3 | pages = 563-94 | year = 1998 | id = PMID 9891698}}</ref> <!--
--->and possibly [[celiac disease]]<!--
-    --><ref name=Tursi>{{cite journal | author = Tursi A, Brandimarte G, Giorgetti G | title = High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. | journal = Am J Gastroenterol | volume = 98 | issue = 4 | pages = 839-43 | year = 2003 | id = PMID 12738465}}</ref> <!--
--->cause diffuse slowing of the bowel, leading to increased bacterial concentrations.  More commonly, the small bowel may have anatomical problems, such as out-pouchings known as [[diverticula]] that can cause bacteria to accumulate.<!--
-   --><ref name=Kongara>{{cite journal | author = Kongara K, Soffer E | title = Intestinal motility in small bowel diverticulosis: a case report and review of the literature. | journal = J Clin Gastroenterol | volume = 30 | issue = 1 | pages = 84-6 | year = 2000 | id = PMID 10636218}}  </ref><!--
--->  After surgery involving the [[stomach]] and [[duodenum]] (most commonly with [[Billroth II]] antrectomy), a ''blind loop'' may be formed, leading to stasis of flow of intestinal contents.  This can cause overgrowth, and is termed ''blind loop syndrome''.<!--
-   --><ref name=Kim>{{cite journal | author = Isaacs P, Kim Y | title = Blind loop syndrome and small bowel bacterial contamination. | journal = Clin Gastroenterol | volume = 12 | issue = 2 | pages = 395-414 | year = 1983 | id = PMID 6347463}}</ref><!--
--->
-Disorders of the immune system can cause bacterial overgrowth.  Chronic [[pancreatitis]], or inflammation of the [[pancreas]] can cause bacterial overgrowth through mechanisms linked to this.<!--
-   --><ref>{{cite journal | author = Trespi E, Ferrieri A | title = Intestinal bacterial overgrowth during chronic pancreatitis. | journal = Curr Med Res Opin | volume = 15 | issue = 1 | pages = 47-52 | year = 1999 | id = PMID 10216811}}</ref>  <!--
--->The use of [[immunosuppressant]] medications to treat other conditions can cause this, as evidenced from animal models.<!--
-   --><ref name=Marshall>{{cite journal | author = Marshall J, Christou N, Meakins J | title = Small-bowel bacterial overgrowth and systemic immunosuppression in experimental peritonitis. | journal = Surgery | volume = 104 | issue = 2 | pages = 404-11 | year = 1988 | id = PMID 3041643}}</ref>  <!--
--->  Other causes include inherited immunodeficiency conditions, such as [[combined variable immunodeficiency]], IgA deficiency, and [[hypogammaglobulinemia]].<!--
-   --><ref name=Pediatrics>{{cite journal | author = Pignata C, Budillon G, Monaco G, Nani E, Cuomo R, Parrilli G, Ciccimarra F | title = Jejunal bacterial overgrowth and intestinal permeability in children with immunodeficiency syndromes. | journal = Gut | volume = 31 | issue = 8 | pages = 879-82 | year = 1990 | id = PMID 2387510}}</ref><!--
--->
-Finally, abnormal connections between the [[bacteria]]-rich colon and the small bowel can increase the bacterial load in the small bowel.  Patients with [[Crohn's disease]] or other diseases of the [[ileum]] may require surgery that removes the [[ileo-cecal valve]] connecting the small and large bowel; this leads to an increased reflux of bacteria into the small bowel.<!--
-  --><ref name-Kholoussy>{{cite journal | author = Kholoussy A, Yang Y, Bonacquisti K, Witkowski T, Takenaka K, Matsumoto T | title = The competence and bacteriologic effect of the telescoped intestinal valve after small bowel resection. | journal = Am Surg | volume = 52 | issue = 10 | pages = 555-9 | year = 1986 | id = PMID 3767143}}</ref>  <!--
--->  After [[bariatric surgery]] for obesity, connections between the stomach and the [[ileum]] can be formed, which may increase bacterial load in the small bowel.<!--
-   --><ref name=AJS>{{cite journal | author = Abell T, Minocha A | title = Gastrointestinal complications of bariatric surgery: diagnosis and therapy. | journal = Am J Med Sci | volume = 331 | issue = 4 | pages = 214-8 | year = 2006 | id = PMID 16617237}}</ref>  <!--
--->[[Proton pump inhibitor]] medications that decrease acid in the [[stomach]] cause bacterial overgrowth by a similar mechanism, as they prevent the anti-bacterial effects of acid in the stomach.  The clinical significance of this in causing symptoms is unclear.<!--
-   --><ref name=PPI>{{cite journal | author = Laine L, Ahnen D, McClain C, Solcia E, Walsh J | title = Review article: potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors. | journal = Aliment Pharmacol Ther | volume = 14 | issue = 6 | pages = 651-68 | year = 2000 | id = PMID 10848649}}</ref><ref name=PPI2>{{cite journal | author = Williams C, McColl K | title = Review article: proton pump inhibitors and bacterial overgrowth. | journal = Aliment Pharmacol Ther | volume = 23 | issue = 1 | pages = 3-10 | year = 2006 | id = PMID 16393275}}</ref>
-==Diagnosis==
-[[Image:Agar plate with colonies.jpg|left|thumb|Aspiration of from the [[jejunum]] is the gold standard for diagnosis.  A bacterial load of greater than 10<sup>5</sup> bacteria per milillitre is diagnostic for bacterial overgrowth]]
-The diagnosis of bacterial overgrowth can be made by physicians in various ways.  [[Malabsorption]] can be detected by a test called the ''D-xylose'' test.  [[Xylose]] is a sugar that does not require enzymes to be digested.  The D-xylose test involves having a patient to drink a certain quantity of D-xylose, and measuring levels in the [[urine]] and [[blood]]; if there is no evidence of D-xylose in the [[urine]] and [[blood]], it suggests that the small bowel is not absorbing properly (as opposed to problems with enzymes required for digestion).<!--
-   --><ref name=Dxylose>{{cite journal | author = Craig R, Atkinson A | title = D-xylose testing: a review. | journal = Gastroenterology | volume = 95 | issue = 1 | pages = 223-31 | year = 1988 | id = PMID 3286361}}</ref><!--
--->
-The gold standard for detection of bacterial overgrowth is the aspiration of more than 10<sup>5</sup> bacteria per millilitre from the small bowel.  The normal small bowel has less than 10<sup>4</sup> bacteria per millilitre.<!--
-   --><ref name=Corazza>{{cite journal | author = Corazza G, Menozzi M, Strocchi A, Rasciti L, Vaira D, Lecchini R, Avanzini P, Chezzi C, Gasbarrini G | title = The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing. | journal = Gastroenterology | volume = 98 | issue = 2 | pages = 302-9 | year = 1990 | id = PMID 2295385}}</ref><!--
--->
-[[Image:Coeliac path.jpg|thumb|left|Biopsies of the small bowel in bacterial overgrowth can mimic [[celiac disease]], with partial [[villi|villous]] atrophy.]]
-Breath tests have been developed to test for bacterial overgrowth, based on bacterial metabolism of [[carbohydrates]] to [[hydrogen]], or based on the detection of by-products of digestion of carbohydrates that are not usually metabolized.  The hydrogen breath test involves giving patients a load of carbohydrate (usually in the form of [[rice]]) and measuring expired hydrogen concentrations after a certain time.  It compares well to jejunal aspirates in making the diagnosis of bacterial overgrowth.<!--
-   --><ref name=Kerlin>{{cite journal | author = Kerlin P, Wong L | title = Breath hydrogen testing in bacterial overgrowth of the small intestine. |
-journal = Gastroenterology | volume = 95 | issue = 4 | pages = 982-8 | year = 1988 | id = PMID 3410238}}</ref>  <!--
---><sup>13</sup>C and <sup>14</sup>C based tests have also been developed based on the bacterial metabolism of D-xylose.  Increased bacterial concentrations are also involved in the deconjugation of bile acids.  The glycocholic acid breath test involves the administration of the bile acid <sup>14</sup>C glychocholic acid, and the detection of <sup>14</sup>CO<sub>2</sub>, which would be elevated in bacterial overgrowth.<!--
-   --><ref name=Geri>{{cite journal | author = Donald I, Kitchingmam G, Donald F, Kupfer R | title = The diagnosis of small bowel bacterial overgrowth in elderly patients. | journal = J Am Geriatr Soc | volume = 40 | issue = 7 | pages = 692-6 | year = 1992 | id = PMID 1607585}}</ref>  <!--
--->
-Some patients with symptoms of [[bacterial overgrowth]] will undergo [[gastroscopy]], or visualization of the stomach and duodenum with an endoscopic [[camera]].  Biopsies of the small bowel in [[bacterial overgrowth]] can mimic those of [[celiac disease]], making the diagnosis more challenging.  Findings include blunting of [[villi]], hyperplasia of crypts and an increased number of [[lymphocyte]]s in the [[lamina propria]].<!--
---><ref name=Toskes>{{cite journal | author = Toskes P, Giannella R, Jervis H, Rout W, Takeuchi A | title = Small intestinal mucosal injury in the experimental blind loop syndrome. Light- and electron-microscopic and histochemical studies. | journal = Gastroenterology | volume = 68 | issue = 5 Pt 1 | pages = 1193-203 | year = 1975 | id = PMID 1126607}}</ref><!--
--->
-However, some physicians suggest that if the suspicion of bacterial overgrowth is high enough, the best diagnostic test is a trial of treatment.  If the symptoms improve, an empiric diagnosis of bacterial overgrowth can be made.<!--
-    --><ref name=Singh>{{cite journal | author = Singh VV, Toskes PP | title = Small Bowel Bacterial Overgrowth: Presentation, Diagnosis, and Treatment. | journal = Curr Treat Options Gastroenterol | volume = 7 | issue = 1 | pages = 19-28 | year = 2004 | id = PMID 14723835}}</ref>
-==Treatment==
-Bacterial overgrowth is usually treated with a course of antibiotics.  A variety of antibiotics, including [[neomycin]], [[rifaximin]], [[amoxicillin-clavulanate]], [[fluoroquinolone]] antibiotics and [[tetracycline]] have been used; however, the best evidence is for the use of [[norfloxacin]] and [[amoxicillin-clavulanate]].<!--
-    --><ref name=RCT>{{cite journal | author = Attar A, Flourié B, Rambaud J, Franchisseur C, Ruszniewski P, Bouhnik Y | title = Antibiotic efficacy in small intestinal bacterial overgrowth-related chronic diarrhea: a crossover, randomized trial. | journal = Gastroenterology | volume = 117 | issue = 4 | pages = 794-7 | year = 1999 | id = PMID 10500060}}</ref>
-A course of one week of antibiotics is usually sufficient to treat the condition.  However, if the condition recurs, antibiotics can be given in a cyclical fashion in order to prevent tolerance.  For example, antibiotics may be given for a week, followed by three weeks off antibiotics, followed by another week of treatment.  Alternatively, the choice of antibiotic used can be cycled.<ref name=Singh/>
-The condition that predisposed the patient to bacterial overgrowth should also be treated.  For example, if the bacterial overgrowth is caused by [[chronic pancreatitis]], the patient should be treated with coated pancreatic [[enzyme]] supplements.
-[[Probiotic]]s are bacterial preparations that alter the bacterial flora in the bowel to cause a beneficial effect.  Their role in bacterial overgrowth is somewhat uncertain.<ref name=Quigley/>
 ==References==

Small intestinal bacterial overgrowth syndrome
ICD-10	K63
ICD-9	579.9
DiseasesDB	29209
MedlinePlus	000222
eMedicine	med/198