Chronic diarrhea classification

Chronic diarrhea Microchapters
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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 is a common symptom of many conditions with an estimated prevalence of 5%. Although chronic diarrhea has multiple definitions, a current working definition is the production of loose stools for longer than 4 weeks’ duration. Additional definitions include passage of 200 g of stool per day or passage of more than 3 bowel movements a day for 3 weeks.

Classification

Chronic diarrhea may be classified into

• Inflammatory diarrhea
• Watery diarrhea
• Fatty 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 disease include;

• Idiopathic inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
• Infectious diseases such as cytomegalovirus, herpes simplex, tuberculosis, strongyloidiasis, Aeromonas or Plesiomonas
• Ischemic colitis,
• Radiation colitis, and
• Neoplasia.

Watery diarhea

Watery diarrhea can be classified as;

• Osmotic diarrhea: this is the more common type however it has a limited differential diagnosis which includes;
  • Ingestion of exogenous magnesium,
  • Carbohydrate malabsorption, or
  • consumption of poorly absorbable carbohydrates.

Magnesium levels can be tested in the stool. A stool pH of less than 6 is suggestive of carbohydrate malabsorption.

• Secretory diarrhea : This is the less common type, the differential diagnosis of secretory diarrhea is quite vast. However, the incidence of these diseases is low. Some of the differentials include but are not limited to;
• Aeromonas
• Plesiomonas
• Microsporidia
• Giardia
• Coccidia
• Cryptosporidium,

Structural and Endocrine diseases should also be considered, including

• Diabetes
• Hyperthyroidism
• Addison’s disease
• eptide-secreting endocrine tumors

Fatty diarrhea

Fatty diarrhea can be described either due to malabsorption or maldigestion problems;

• Malabsorption; 3 most common causes of malabsorption are
  • Celiac sprue
  • Pancreatic insufficiency
  • Bacterial overgrowth
• Maldigestion; Maldigestion results from pancreatic exocrine insufficiency

References

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