Chronic diarrhea other diagnostic studies: Difference between revisions
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==Overview== | ==Overview== | ||
An endoscopic evaluation should be considered if there are persistent symptoms, inconclusive diagnosis, or failure to respond to therapy. Guidelines for the role of endoscopy in the management of patients with diarrhea have been published by the American Society of Gastrointestinal Endoscopy. | An [[endoscopic]] evaluation should be considered if there are persistent [[symptoms]], inconclusive [[diagnosis]], or failure to respond to [[therapy]]. Guidelines for the role of [[endoscopy]] in the management of [[patients]] with [[diarrhea]] have been published by the American Society of Gastrointestinal Endoscopy. | ||
==Other diagnostic studies== | ==Other diagnostic studies== | ||
===Flexible sigmoidoscopy=== | ===Flexible sigmoidoscopy=== | ||
Flexible sigmoidoscopy can be used as an initial diagnostic tool in patients with chronic diarrhea who are pregnant or have significant comorbidities where a colonoscopy is contraindicated. Flexible sigmoidoscopy may | *[[Flexible sigmoidoscopy]] can be used as an initial [[Diagnostic criteria|diagnostic tool]] in patients with chronic [[diarrhea]] who are [[pregnant]] or have significant [[comorbidities]] where a [[colonoscopy]] is contraindicated. | ||
*[[Flexible sigmoidoscopy]] may be sufficient in the [[diagnosis]] as long as [[biopsy]] samples are obtained for [[Histological section|histologic]] evaluation to rule out causes of chronic [[diarrhea]] such as [[microscopic colitis]], even when the [[mucosa]] appears normal. | |||
*There has been much debate over the appropriate [[Endoscopy|endoscopic]] method for evaluating chronic [[diarrhea]]. [[Flexible sigmoidoscopy]] is less expensive and less [[Invasive (medical)|invasive]], with fewer [[Complication (medicine)|complications]] than [[colonoscopy]]. | |||
*However, some cases might be missed if [[biopsy]] samples are only taken from the distal segment of the [[colon]].<ref name="pmid20346452">{{cite journal| author=ASGE Standards of Practice Committee. Shen B, Khan K, Ikenberry SO, Anderson MA, Banerjee S et al.| title=The role of endoscopy in the management of patients with diarrhea. | journal=Gastrointest Endosc | year= 2010 | volume= 71 | issue= 6 | pages= 887-92 | pmid=20346452 | doi=10.1016/j.gie.2009.11.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20346452 }} </ref> | |||
===Colonoscopy=== | ===Colonoscopy=== | ||
Chronic diarrhea can be diagnosed by colonoscopy with biopsy in patients with IBD, microscopic inflammatory disorders, and colorectal neoplasia.<ref name="pmid16564852">{{cite journal| author=Leighton JA, Shen B, Baron TH, Adler DG, Davila R, Egan JV et al.| title=ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease. | journal=Gastrointest Endosc | year= 2006 | volume= 63 | issue= 4 | pages= 558-65 | pmid=16564852 | doi=10.1016/j.gie.2006.02.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16564852 }} </ref> | * Chronic [[diarrhea]] can be diagnosed by [[colonoscopy]] with [[biopsy]] in patients with [[IBD]], [[Microscopic colitis|microscopic]] inflammatory disorders, and [[Colorectal cancer|colorectal neoplasia]].<ref name="pmid16564852">{{cite journal| author=Leighton JA, Shen B, Baron TH, Adler DG, Davila R, Egan JV et al.| title=ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease. | journal=Gastrointest Endosc | year= 2006 | volume= 63 | issue= 4 | pages= 558-65 | pmid=16564852 | doi=10.1016/j.gie.2006.02.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16564852 }} </ref> | ||
===Esophagogastroduodenoscopy=== | ===Esophagogastroduodenoscopy=== | ||
Esophagogastroduodenoscopy (EGD) can be | *[[Esophagogastroduodenoscopy]] (EGD) can be useful in the evaluation of patients with [[IBD]]. | ||
*[[Crohn's disease]] can involve the [[esophagus]], [[stomach]], and [[duodenum]]. | |||
*[[Duodenal|Duodenal biopsies]] have been found to show more [[granulomas]] (40%-68%) than colon biopsies.<ref name="pmid11383583">{{cite journal| author=Decker GA, Loftus EV, Pasha TM, Tremaine WJ, Sandborn WJ| title=Crohn's disease of the esophagus: clinical features and outcomes. | journal=Inflamm Bowel Dis | year= 2001 | volume= 7 | issue= 2 | pages= 113-9 | pmid=11383583 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11383583 }} </ref><ref name="pmid16278730">{{cite journal| author=Kefalas CH| title=Gastroduodenal Crohn's disease. | journal=Proc (Bayl Univ Med Cent) | year= 2003 | volume= 16 | issue= 2 | pages= 147-51 | pmid=16278730 | doi= | pmc=1201000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16278730 }} </ref><ref name="pmid11374684">{{cite journal| author=Wahab PJ, Crusius JB, Meijer JW, Mulder CJ| title=Gluten challenge in borderline gluten-sensitive enteropathy. | journal=Am J Gastroenterol | year= 2001 | volume= 96 | issue= 5 | pages= 1464-9 | pmid=11374684 | doi=10.1111/j.1572-0241.2001.03812.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11374684 }} </ref> | |||
===Capsule endoscopy=== | |||
*[[Capsule endoscopy]] allows for direct and minimally invasive visualization of [[small bowel]] [[mucosa]]. | |||
*It has been used to identify superficial [[lesions]] not detected by traditional [[endoscopy]] and [[radiography]]. | |||
*It might be useful in the initial diagnosis of [[Crohn's disease]], for detecting recurrences, for establishing extent of [[disease]], for assessing response to [[therapy]], and for differentiating [[Crohn's disease]] from [[ulcerative colitis]] or indeterminate colitis. | |||
*In a study [[Capsule endoscopy]] showed the highest [[Sensitivity (tests)|sensitivity]] (83%) with the lowest [[Specificity (tests)|specificity]] (53%) and [[colonoscopy]] with [[ileoscopy]] had the highest [[Specificity (tests)|specificity]] (100%) with a [[Sensitivity (tests)|sensitivity]] of 74% for diagnosis of [[crohn's disease]].<ref name="pmid18513722">{{cite journal| author=Solem CA, Loftus EV, Fletcher JG, Baron TH, Gostout CJ, Petersen BT et al.| title=Small-bowel imaging in Crohn's disease: a prospective, blinded, 4-way comparison trial. | journal=Gastrointest Endosc | year= 2008 | volume= 68 | issue= 2 | pages= 255-66 | pmid=18513722 | doi=10.1016/j.gie.2008.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18513722 }} </ref> | |||
==References== | ==References== | ||
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[[Category:Emergency medicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Pediatrics]] | |||
Latest revision as of 20:57, 29 July 2020
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Chronic diarrhea Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
An endoscopic evaluation should be considered if there are persistent symptoms, inconclusive diagnosis, or failure to respond to therapy. Guidelines for the role of endoscopy in the management of patients with diarrhea have been published by the American Society of Gastrointestinal Endoscopy.
Other diagnostic studies
Flexible sigmoidoscopy
- Flexible sigmoidoscopy can be used as an initial diagnostic tool in patients with chronic diarrhea who are pregnant or have significant comorbidities where a colonoscopy is contraindicated.
- Flexible sigmoidoscopy may be sufficient in the diagnosis as long as biopsy samples are obtained for histologic evaluation to rule out causes of chronic diarrhea such as microscopic colitis, even when the mucosa appears normal.
- There has been much debate over the appropriate endoscopic method for evaluating chronic diarrhea. Flexible sigmoidoscopy is less expensive and less invasive, with fewer complications than colonoscopy.
- However, some cases might be missed if biopsy samples are only taken from the distal segment of the colon.[1]
Colonoscopy
- Chronic diarrhea can be diagnosed by colonoscopy with biopsy in patients with IBD, microscopic inflammatory disorders, and colorectal neoplasia.[2]
Esophagogastroduodenoscopy
- Esophagogastroduodenoscopy (EGD) can be useful in the evaluation of patients with IBD.
- Crohn's disease can involve the esophagus, stomach, and duodenum.
- Duodenal biopsies have been found to show more granulomas (40%-68%) than colon biopsies.[3][4][5]
Capsule endoscopy
- Capsule endoscopy allows for direct and minimally invasive visualization of small bowel mucosa.
- It has been used to identify superficial lesions not detected by traditional endoscopy and radiography.
- It might be useful in the initial diagnosis of Crohn's disease, for detecting recurrences, for establishing extent of disease, for assessing response to therapy, and for differentiating Crohn's disease from ulcerative colitis or indeterminate colitis.
- In a study Capsule endoscopy showed the highest sensitivity (83%) with the lowest specificity (53%) and colonoscopy with ileoscopy had the highest specificity (100%) with a sensitivity of 74% for diagnosis of crohn's disease.[6]
References
- ↑ ASGE Standards of Practice Committee. Shen B, Khan K, Ikenberry SO, Anderson MA, Banerjee S; et al. (2010). "The role of endoscopy in the management of patients with diarrhea". Gastrointest Endosc. 71 (6): 887–92. doi:10.1016/j.gie.2009.11.025. PMID 20346452.
- ↑ Leighton JA, Shen B, Baron TH, Adler DG, Davila R, Egan JV; et al. (2006). "ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease". Gastrointest Endosc. 63 (4): 558–65. doi:10.1016/j.gie.2006.02.005. PMID 16564852.
- ↑ Decker GA, Loftus EV, Pasha TM, Tremaine WJ, Sandborn WJ (2001). "Crohn's disease of the esophagus: clinical features and outcomes". Inflamm Bowel Dis. 7 (2): 113–9. PMID 11383583.
- ↑ Kefalas CH (2003). "Gastroduodenal Crohn's disease". Proc (Bayl Univ Med Cent). 16 (2): 147–51. PMC 1201000. PMID 16278730.
- ↑ Wahab PJ, Crusius JB, Meijer JW, Mulder CJ (2001). "Gluten challenge in borderline gluten-sensitive enteropathy". Am J Gastroenterol. 96 (5): 1464–9. doi:10.1111/j.1572-0241.2001.03812.x. PMID 11374684.
- ↑ Solem CA, Loftus EV, Fletcher JG, Baron TH, Gostout CJ, Petersen BT; et al. (2008). "Small-bowel imaging in Crohn's disease: a prospective, blinded, 4-way comparison trial". Gastrointest Endosc. 68 (2): 255–66. doi:10.1016/j.gie.2008.02.017. PMID 18513722.