Chronic diarrhea classification: Difference between revisions
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==Overview== | ==Overview== | ||
Chronic diarrhea may be classified into 3 basic categories: [[Watery diarrhea|watery]], | Chronic [[diarrhea]] may be classified into 3 basic categories: [[Watery diarrhea|watery]], fatty ([[malabsorption]]), and [[inflammatory]] (with [[blood]] and [[pus]]). It is important to note that not all [[chronic diarrhea]] falls into one category alone. Classifying a patient's [[chronic diarrhea]] into a subcategory helps to direct the [[diagnostic]] workup. | ||
==Classification== | ==Classification== | ||
Chronic diarrhea may be classified into:<ref name="FineSchiller1999">{{cite journal|last1=Fine|first1=K|last2=Schiller|first2=L|title=AGA Technical Review on the Evaluation and Management of Chronic Diarrhea☆|journal=Gastroenterology|volume=116|issue=6|year=1999|pages=1464–1486|issn=00165085|doi=10.1016/S0016-5085(99)70513-5}}</ref><ref>{{cite journal|title=American Gastroenterological Association medical position statement: Guidelines for the evaluation and management of chronic diarrhea☆, ☆☆|journal=Gastroenterology|volume=116|issue=6|year=1999|pages=1461–1463|issn=00165085|doi=10.1016/S0016-5085(99)70512-3}}</ref><ref name="pmid15017602">{{cite journal| author=Camilleri M| title=Chronic diarrhea: a review on pathophysiology and management for the clinical gastroenterologist. | journal=Clin Gastroenterol Hepatol | year= 2004 | volume= 2 | issue= 3 | pages= 198-206 | pmid=15017602 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15017602 }} </ref><ref name="pmid10699778">{{cite journal| author=Fine KD, Seidel RH, Do K| title=The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea. | journal=Gastrointest Endosc | year= 2000 | volume= 51 | issue= 3 | pages= 318-26 | pmid=10699778 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10699778 }} </ref> | Chronic [[diarrhea]] may be classified into:<ref name="FineSchiller1999">{{cite journal|last1=Fine|first1=K|last2=Schiller|first2=L|title=AGA Technical Review on the Evaluation and Management of Chronic Diarrhea☆|journal=Gastroenterology|volume=116|issue=6|year=1999|pages=1464–1486|issn=00165085|doi=10.1016/S0016-5085(99)70513-5}}</ref><ref>{{cite journal|title=American Gastroenterological Association medical position statement: Guidelines for the evaluation and management of chronic diarrhea☆, ☆☆|journal=Gastroenterology|volume=116|issue=6|year=1999|pages=1461–1463|issn=00165085|doi=10.1016/S0016-5085(99)70512-3}}</ref><ref name="pmid15017602">{{cite journal| author=Camilleri M| title=Chronic diarrhea: a review on pathophysiology and management for the clinical gastroenterologist. | journal=Clin Gastroenterol Hepatol | year= 2004 | volume= 2 | issue= 3 | pages= 198-206 | pmid=15017602 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15017602 }} </ref><ref name="pmid10699778">{{cite journal| author=Fine KD, Seidel RH, Do K| title=The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea. | journal=Gastrointest Endosc | year= 2000 | volume= 51 | issue= 3 | pages= 318-26 | pmid=10699778 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10699778 }} </ref> | ||
*[[Inflammatory|Inflammatory diarrhea]] | *[[Inflammatory|Inflammatory diarrhea]] | ||
*[[Watery diarrhea]] | *[[Watery diarrhea]] | ||
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===Inflammatory diarrhea=== | ===Inflammatory diarrhea=== | ||
Diarrhea | [[Diarrhea (patient information)|Diarrhea]] may be classified as [[inflammatory]], when [[Stool examination|stool analysis]] tools, such as [[Stool culture|stool cultures]] and interventions, such as [[flexible sigmoidoscopy]] or [[colonoscopy]] with [[biopsies]] show evidence of the presence of [[Fecal occult blood|fecal leukocytes]]. Causes of [[Inflammatory|inflammatory diarrhea]] include: | ||
*Idiopathic [[inflammatory bowel disease]] such as [[Crohn’s disease]] or [[ulcerative colitis]] | *[[Idiopathic]] [[inflammatory bowel disease]], such as [[Crohn’s disease]] or [[ulcerative colitis]] | ||
*Infectious diseases such as [[ | *[[Infectious disease|Infectious diseases]] such as: | ||
**[[Cytomegalovirus]] | |||
**[[Herpes simplex]] | |||
**[[Tuberculosis]] | |||
**[[Strongyloidiasis]] | |||
**''[[Aeromonas]]'' | |||
**''[[Plesiomonas shigelloides|Plesiomonas]]'' | |||
*[[Ischemic colitis]] | *[[Ischemic colitis]] | ||
*[[Radiation colitis]] | *[[Radiation colitis]] | ||
*[[Neoplasia]] | *[[Neoplasia]] | ||
===Watery | ===Watery diarrhea=== | ||
Watery diarrhea can be classified as | Watery [[diarrhea]] can be classified as: | ||
*Osmotic diarrhea: | *Osmotic [[diarrhea]] ([[stools]] with high osmotic gap >100 mosm/kg). Causes of osmotic [[diarrhea]] include: | ||
** | **[[Celiac sprue]] | ||
** | **[[Chronic pancreatitis]] | ||
** | **[[Lactase deficiency]] | ||
**[[Lactulose]] | |||
**[[Laxative abuse|Laxative use/abuse]] | |||
**[[Whipple's disease]] | |||
*Secretory diarrhea | *Secretory [[diarrhea]] ([[stools]] with low osmotic gap <50 mosm/kg). Causes of secretory [[diarrhea]] include: | ||
**[[Aeromonas]] | **[[Cholera]] | ||
**[[Plesiomonas shigelloides|Plesiomonas]] | **[[ETEC|Enterotoxigenic strains of ''E. coli'']] | ||
**[[Medullary thyroid carcinoma]] | |||
**[[Factitious disorders|Factitious diarrhea]] from [[laxative abuse]]<ref name="pmid7234824">{{cite journal| author=Oster JR, Materson BJ, Rogers AI| title=Laxative abuse syndrome. | journal=Am J Gastroenterol | year= 1980 | volume= 74 | issue= 5 | pages= 451-8 | pmid=7234824 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7234824 }} </ref> | |||
**[[Villous adenoma]] | |||
**''[[Aeromonas]]'' | |||
**''[[Plesiomonas shigelloides|Plesiomonas]]'' | |||
**[[Microsporidia]] | **[[Microsporidia]] | ||
**[[Giardia]] | **''[[Giardia]]'' | ||
**[[Coccidia]] | **[[Coccidia]] | ||
**[[Cryptosporidium]] | **''[[Cryptosporidium]]'' | ||
* Structural and Endocrine diseases should also be considered. These diseases include the following: | * Structural and [[Endocrine system|endocrine]] [[diseases]] should also be considered. These [[diseases]] include the following: | ||
** [[Diabetes]] | ** [[Diabetes]] | ||
** [[Hyperthyroidism]] | ** [[Hyperthyroidism]] | ||
** [[Addison's disease]] | ** [[Addison's disease]] | ||
** Peptide secreting [[endocrine tumors]] | ** [[Peptide]] secreting [[endocrine tumors]] | ||
A normal gap is between 50 and 100 mosm/kg.<ref name="Shiau1985">{{cite journal|last1=Shiau|first1=Yih-Fu|title=Stool Electrolyte and Osmolality Measurements in the Evaluation of Diarrheal Disorders|journal=Annals of Internal Medicine|volume=102|issue=6|year=1985|pages=773|issn=0003-4819|doi=10.7326/0003-4819-102-6-773}}</ref> | |||
===Fatty diarrhea=== | ===Fatty diarrhea=== | ||
Fatty diarrhea can be | Fatty [[diarrhea]] can be either due to [[malabsorption]] or [[maldigestion]] problems: | ||
* | *The most common causes of [[malabsorption]] are: | ||
**[[Celiac sprue]] | **[[Celiac sprue]] | ||
**[[Pancreatic insufficiency]] | **[[Pancreatic insufficiency]] | ||
**[[Bacterial overgrowth]] | **[[Bacterial overgrowth]] | ||
*Maldigestion | *[[Maldigestion]] results from [[Pancreatic insufficiency|pancreatic exocrine insufficiency]] | ||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Emergency medicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Pediatrics]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 13:21, 15 January 2021
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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
Chronic diarrhea may be classified into 3 basic categories: watery, fatty (malabsorption), and inflammatory (with blood and pus). It is important to note that not all chronic diarrhea falls into one category alone. Classifying a patient's chronic diarrhea into a subcategory helps to direct the diagnostic workup.
Classification
Chronic diarrhea may be classified into:[1][2][3][4]
Inflammatory diarrhea
Diarrhea may be classified as inflammatory, when stool analysis tools, such as stool cultures and interventions, such as flexible sigmoidoscopy or colonoscopy with biopsies show evidence of the presence of fecal leukocytes. Causes of inflammatory diarrhea include:
- Idiopathic inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
- Infectious diseases such as:
- Ischemic colitis
- Radiation colitis
- Neoplasia
Watery diarrhea
Watery diarrhea can be classified as:
A normal gap is between 50 and 100 mosm/kg.[6]
Fatty diarrhea
Fatty diarrhea can be either due to malabsorption or maldigestion problems:
- The most common causes of malabsorption are:
- Maldigestion results from pancreatic exocrine insufficiency
References
- ↑ Fine, K; Schiller, L (1999). "AGA Technical Review on the Evaluation and Management of Chronic Diarrhea☆". Gastroenterology. 116 (6): 1464–1486. doi:10.1016/S0016-5085(99)70513-5. ISSN 0016-5085.
- ↑ "American Gastroenterological Association medical position statement: Guidelines for the evaluation and management of chronic diarrhea☆, ☆☆". Gastroenterology. 116 (6): 1461–1463. 1999. doi:10.1016/S0016-5085(99)70512-3. ISSN 0016-5085.
- ↑ Camilleri M (2004). "Chronic diarrhea: a review on pathophysiology and management for the clinical gastroenterologist". Clin Gastroenterol Hepatol. 2 (3): 198–206. PMID 15017602.
- ↑ Fine KD, Seidel RH, Do K (2000). "The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea". Gastrointest Endosc. 51 (3): 318–26. PMID 10699778.
- ↑ Oster JR, Materson BJ, Rogers AI (1980). "Laxative abuse syndrome". Am J Gastroenterol. 74 (5): 451–8. PMID 7234824.
- ↑ Shiau, Yih-Fu (1985). "Stool Electrolyte and Osmolality Measurements in the Evaluation of Diarrheal Disorders". Annals of Internal Medicine. 102 (6): 773. doi:10.7326/0003-4819-102-6-773. ISSN 0003-4819.