Chronic diarrhea classification: Difference between revisions

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==Overview==
==Overview==
Chronic diarrhea may be classified into 3 basic categories: [[Watery diarrhea|watery]], [[Steatorrhea|fatty]]([[malabsorption]]) and [[inflammatory]] (with blood and pus). It is important to note that not all chronic diarrhea falls into one category alone. The differential diagnosis for chronic diarrhea is enormous, with a large number of diagnostic tests available that can be used to evaluate these patients. Classifying the patient with chronic diarrhea into a subcategory helps to direct the diagnostic work-up.
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 is said to be due to an [[inflammatory]] cause when stool analysis such as stool cultures, [[flexible sigmoidoscopy]] or [[colonoscopy]] with biopsies show evidence of the presence of fecal leukocytes. Causes of inflammatory diarrhea include;
[[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 disease|Infectious diseases]] such as [[cytomegalovirus]], [[herpes simplex]], [[tuberculosis]], [[strongyloidiasis]], [[Aeromonas]] or [[Plesiomonas shigelloides|Plesiomonas]]
*[[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 diarhea===
===Watery diarrhea===
Watery diarrhea can be classified as;
Watery [[diarrhea]] can be classified as:
*Osmotic diarrhea: [[Stools]] with high osmotic gap (>100 mosm/kg). Causes of osmotic diarrhea include;
*Osmotic [[diarrhea]] ([[stools]] with high osmotic gap >100 mosm/kg). Causes of osmotic [[diarrhea]] include:
**[[Celiac sprue]]  
**[[Celiac sprue]]  
**[[Chronic pancreatitis]]
**[[Chronic pancreatitis]]
**[[Lactase deficiency]]
**[[Lactase deficiency]]
**[[Lactulose]]
**[[Lactulose]]
**[[Laxative abuse|Laxative use/abuse]], and
**[[Laxative abuse|Laxative use/abuse]]
**[[Whipple's disease]]
**[[Whipple's disease]]


*Secretory diarrhea : Stools with low osmotic gap (<50 mosm/kg) causes of secretory diarrhea include;
*Secretory [[diarrhea]] ([[stools]] with low osmotic gap <50 mosm/kg). Causes of secretory [[diarrhea]] include:
**[[Cholera]]  
**[[Cholera]]  
**[[ETEC|Enterotoxigenic strains of E. coli]]  
**[[ETEC|Enterotoxigenic strains of ''E. coli'']]  
**[[Medullary thyroid carcinoma]]  
**[[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>
**[[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|Villous adenoma.]]
**[[Villous adenoma]]
**[[Aeromonas]]  
**''[[Aeromonas]]''
**[[Plesiomonas shigelloides|Plesiomonas]]
**''[[Plesiomonas shigelloides|Plesiomonas]]''
**[[Microsporidia]]
**[[Microsporidia]]
**[[Giardia]]
**''[[Giardia]]''
**[[Coccidia]]
**[[Coccidia]]
**[[Cryptosporidium]],
**''[[Cryptosporidium]]''


* Structural and [[Endocrine system|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]]
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===Fatty diarrhea===
===Fatty diarrhea===
Fatty diarrhea can be described either due to [[malabsorption]] or [[maldigestion]] problems;
Fatty [[diarrhea]] can be either due to [[malabsorption]] or [[maldigestion]] problems:
*[[Malabsorption]]; 3 most common causes of [[malabsorption]] are  
*The most common causes of [[malabsorption]] are:
**[[Celiac sprue]]
**[[Celiac sprue]]
**[[Pancreatic insufficiency]]
**[[Pancreatic insufficiency]]
**[[Bacterial overgrowth]]
**[[Bacterial overgrowth]]
*[[Maldigestion]]; It results from [[Pancreatic insufficiency|pancreatic exocrine insufficiency]].
*[[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

Chronic diarrhea Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chronic diarrhea from other Diseases

Epidemiology and Demographics

Risk Factors

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Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

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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

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:

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:

References

  1. ↑ 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.
  2. ↑ "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.
  3. ↑ Camilleri M (2004). "Chronic diarrhea: a review on pathophysiology and management for the clinical gastroenterologist". Clin Gastroenterol Hepatol. 2 (3): 198–206. PMID 15017602.
  4. ↑ 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.
  5. ↑ Oster JR, Materson BJ, Rogers AI (1980). "Laxative abuse syndrome". Am J Gastroenterol. 74 (5): 451–8. PMID 7234824.
  6. ↑ 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.


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