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

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==Overview==
==Overview==
If left untreated, patients with [[chronic diarrhea]] may progress to develop symptoms of [[Altered mental status|altered sensorium]] 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.
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 [[symptoms]] of chronic diarrhea usually develop within 4 weeks and start with [[symptoms]] such as [[abdominal pain]], voluminous [[watery diarrhea]] due to disorders of the [[Colon (anatomy)|colon]], fatty or [[Bloody diarrhea|bloody]] loose bowel movement, alteration of [[diarrhea]] and [[constipation]] as seen in [[irritable bowel disease]]. The symptoms of chronic diarrhea are usually as a result of [[medications]], [[genetic disorders]], and rarely due to [[viral]], [[bacterial]] or [[parasitic]] [[infections]]. It is important to ask for [[risk factors]] such as recent [[Travel diarrhea|travel]] history, occurence of [[diarrhea]] during fasting or at night, [[weight loss]], [[family history]] of [[Inflammatory bowel disease|IBD]], use of [[medications]] (including [[over-the-counter drugs]] and [[supplements]]), presence of [[Systemic Constellations|systemic symptoms]], which may indicate [[IBD]] (such as [[fevers]], [[joint pains]], [[mouth ulcers]], [[conjunctivitis]]) and promiscuous sexual activity is a risk factor associated with [[HIV]] infection. Without treatment, the patient will develop symptoms of [[dehydration]], [[malnutrition]], [[altered mental status]], [[sepsis]] and eventually [[coma]] or death.
Without treatment, the patient will develop [[symptoms]] of [[dehydration]], [[malnutrition]], [[altered mental status]], [[sepsis]], and eventually [[coma]] or death.


==Complications==
==Complications==
Depending on the underlying cause, [[Chronic (medical)|chronic]] or [[Diarrhea|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 IV [[Oral rehydration salt|oral rehydration solution]] to replace the [[Intravenous fluids|fluids]] and [[Electrolyte|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 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>
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<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]]
* [[Rectal bleeding]]
*[[Weight loss]]
*[[Weight loss]]
*Age > 50 years
*[[Age]] > 50 years
*Pain
*[[Pain]]
*Associated psychological factors
*Associated [[Psychology|psychological]] factors
*[[Somatization]]
*[[Somatization]]


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[[Category:Up-To-Date]]

Latest revision as of 13:24, 15 January 2021

Chronic diarrhea Microchapters

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Overview

Historical Perspective

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Pathophysiology

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Differentiating Chronic diarrhea from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

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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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