Chronic diarrhea natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
The natural history of chronic diarrhea is [[Watery diarrhea|watery]] or [[Bloody diarrhea|bloody]] or [[Steatorrhea|fatty stools]] for more than 4 weeks duration. Depending on the underlying cause, chronic or severe diarrhea can lead to potentially serious complications some of which include but are not limited to [[dehydration]] and [[malnutrition]]. The prognosis of chronic diarrhea is good especially when the underlying cause is identified early and treated.
If left untreated, patients with [[chronic diarrhea]] may progress to develop [[symptoms]] of [[Altered mental status|altered consciousness]] due to [[electrolyte imbalance]], [[dehydration]], and [[malnutrition]]. Common [[complications]] of [[chronic diarrhea]] include [[confusion]], perforated bowels, [[sepsis]], and death. [[Prognosis]] is generally good when the underlying cause is identified and treated early.


===Natural History===
==Natural History==
The natural history of chronic diarrhea is [[Watery diarrhea|watery]] or [[Bloody diarrhea|bloody]] or [[fatty stools]] for more than 4 weeks duration associated with any of the following;
Without treatment, the patient will develop [[symptoms]] of [[dehydration]], [[malnutrition]], [[altered mental status]], [[sepsis]], and eventually [[coma]] or death.
*Greasy stools that float and are malodorous may suggest fat malabsorption, while the presence of visible blood may suggest [[Inflammatory bowel disease|IBD.]]
*Travel history.
*Risk factors for [[HIV]] infection.
*Weight loss.
*Fecal incontinence (which may be confused with diarrhea).
*Occurrence of diarrhea during fasting or at night (suggesting a secretory diarrhea).
*Family history of [[Inflammatory bowel disease|IBD]].
*Voluminous [[watery diarrhea]] due to disorders of the colon.
*[[Bloody diarrhea]].
*Presence of systemic symptoms, which may indicate [[IBD]] (such as [[fevers]], joint pains, [[mouth ulcers]], eye redness).
*Use of medications (including over-the-counter drugs and supplements) (See Causes section)
*Use of [[Sorbitol|sorbito]]<nowiki/>l-containing products and use of [[alcohol]].
*Association of stress and [[depression]] with onset and severity of the diarrhea.
*Association of symptoms with specific food ingestion (such as dairy products or potential food [[allergens]]).
*A sexual history (anal intercourse is a risk factor for infectious [[proctitis]] and promiscuous sexual activity is a risk factor associated with [[HIV]] infection).
*A history of recurrent bacterial infections (eg, [[sinusitis]], [[pneumonia]]),suggesting a primary [[immunoglobulin]] deficiency.


===Complications===
==Complications==
Depending on the underlying cause, chronic or severe diarrhea can lead to potentially serious complications some of which include but are not limited to dehydration and malnutrition. It is important to keep patients hydrated by taking fluids. patients who are unable to tolerate fluids orally should be given fluids into a vein (IV) to replace the fluids and electrolytes (salts) lost in diarrhea.
Complications that can develop as a result of chronic [[diarrhea]] are:
*[[Dehydration]]
*[[Malnutrition]]
*[[Electrolyte disturbance|Electrolyte disturbance]]


===Prognosis===
==Prognosis==
The prognosis of chronic diarrhea is good especially when the underlying cause is identified early and treated.
The [[prognosis]] of [[chronic diarrhea]] is good especially when the underlying cause is identified early and treated. The presence of these features in a [[patient]] complaining of [[diarrhea]] for over 4 weeks may indicate poor [[prognosis]]:<ref name="pmid16973955">{{cite journal| author=Halfdanarson TR, Litzow MR, Murray JA| title=Hematologic manifestations of celiac disease. | journal=Blood | year= 2007 | volume= 109 | issue= 2 | pages= 412-21 | pmid=16973955 | doi=10.1182/blood-2006-07-031104 | pmc=1785098 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16973955  }} </ref><ref name="pmid14960513">{{cite journal| author=Olesen M, Eriksson S, Bohr J, Järnerot G, Tysk C| title=Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993-1998. | journal=Gut | year= 2004 | volume= 53 | issue= 3 | pages= 346-50 | pmid=14960513 | doi= | pmc=1773978 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14960513  }} </ref><ref name="pmid15784038">{{cite journal| author=Tillisch K, Labus JS, Naliboff BD, Bolus R, Shetzline M, Mayer EA et al.| title=Characterization of the alternating bowel habit subtype in patients with irritable bowel syndrome. | journal=Am J Gastroenterol | year= 2005 | volume= 100 | issue= 4 | pages= 896-904 | pmid=15784038 | doi=10.1111/j.1572-0241.2005.41211.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15784038  }} </ref><ref>{{cite journal|doi=10.1016/j.cgh.2006.11.024 showArticle Info}}</ref><ref name="pmid2254453">{{cite journal| author=Hammer HF, Fine KD, Santa Ana CA, Porter JL, Schiller LR, Fordtran JS| title=Carbohydrate malabsorption. Its measurement and its contribution to diarrhea. | journal=J Clin Invest | year= 1990 | volume= 86 | issue= 6 | pages= 1936-44 | pmid=2254453 | doi=10.1172/JCI114927 | pmc=329829 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2254453  }} </ref>
*[[Dietary]] causes of [[diarrhea]]
* [[Rectal bleeding]]
*[[Weight loss]]
*[[Age]] > 50 years
*[[Pain]]
*Associated [[Psychology|psychological]] factors
*[[Somatization]]


==References==
==References==
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[[Category:Up-To-Date]]

Latest revision as of 13:24, 15 January 2021

Chronic diarrhea Microchapters

Home

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chronic diarrhea from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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

Overview

If left untreated, patients with chronic diarrhea may progress to develop symptoms of altered consciousness due to electrolyte imbalance, dehydration, and malnutrition. Common complications of chronic diarrhea include confusion, perforated bowels, sepsis, and death. Prognosis is generally good when the underlying cause is identified and treated early.

Natural History

Without treatment, the patient will develop symptoms of dehydration, malnutrition, altered mental status, sepsis, and eventually coma or death.

Complications

Complications that can develop as a result of chronic diarrhea are:

Prognosis

The prognosis of chronic diarrhea is good especially when the underlying cause is identified early and treated. The presence of these features in a patient complaining of diarrhea for over 4 weeks may indicate poor prognosis:[1][2][3][4][5]

References

  1. ↑ Halfdanarson TR, Litzow MR, Murray JA (2007). "Hematologic manifestations of celiac disease". Blood. 109 (2): 412–21. doi:10.1182/blood-2006-07-031104. PMC 1785098. PMID 16973955.
  2. ↑ Olesen M, Eriksson S, Bohr J, Järnerot G, Tysk C (2004). "Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993-1998". Gut. 53 (3): 346–50. PMC 1773978. PMID 14960513.
  3. ↑ Tillisch K, Labus JS, Naliboff BD, Bolus R, Shetzline M, Mayer EA; et al. (2005). "Characterization of the alternating bowel habit subtype in patients with irritable bowel syndrome". Am J Gastroenterol. 100 (4): 896–904. doi:10.1111/j.1572-0241.2005.41211.x. PMID 15784038.
  4. ↑ . doi:10.1016/j.cgh.2006.11.024 showArticle Info Check |doi= value (help). Missing or empty |title= (help)
  5. ↑ Hammer HF, Fine KD, Santa Ana CA, Porter JL, Schiller LR, Fordtran JS (1990). "Carbohydrate malabsorption. Its measurement and its contribution to diarrhea". J Clin Invest. 86 (6): 1936–44. doi:10.1172/JCI114927. PMC 329829. PMID 2254453.


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