Chronic diarrhea overview: Difference between revisions
| Line 14: | Line 14: | ||
==Pathophysiology== | ==Pathophysiology== | ||
The fundamental pathophysiology of all diarrhea is incomplete absorption of water from the [[lumen]] either because of a reduced rate of net water absorption (related to impaired [[electrolyte]] absorption or excessive electrolyte secretion) or because of [[osmotic]] retention of water intraluminally. | The fundamental pathophysiology of all diarrhea is incomplete absorption of water from the [[lumen]] either because of a reduced rate of net water absorption (related to impaired [[electrolyte]] absorption or excessive electrolyte secretion) or because of [[osmotic]] retention of water intraluminally. The causes of chronic diarrhea include [[inflammatory]], [[osmotic]], secretory, [[iatrogenic]], motility, and functional diseases. In general, the causes of chronic diarrhea is multifactorial. For example, [[cholera]] is caused by secretion and altered motility whereas [[pseudomembranous colitis]] is said to be associated with secretion, inflammation, and motility. Thus, diarrhea is a condition of altered intestinal water and [[electrolyte]] transport. | ||
==Causes== | ==Causes== | ||
Depending on the socio economic status of the population, chronic diarrhea can be caused by several factors. In a developing nation, the most likely causes of chronic | Depending on the socio economic status of the population, chronic diarrhea can be caused by several factors. In a developing nation, the most likely causes of chronic diarrhea are [[Mycobacterial infection|mycobacterial]] and [[parasitic infections]] and less likely to include functional disorders such as [[malabsorption]] and [[Inflammatory bowel disease|inflammatory bowel diseases]]. In a developed nation however, the most likely cause of diarrhea are [[irritable bowel syndrome]] (IBS), [[inflammatory bowel disease]], [[malabsorption]] syndromes (such as [[lactose intolerance]] and [[celiac disease]]), and chronic infections (particularly in patients who are [[immunocompromised]]). | ||
==Differentiating Chronic Diarrhea from other Conditions== | ==Differentiating Chronic Diarrhea from other Conditions== | ||
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. | The differential diagnosis for [[chronic diarrhea]] is enormous, with a large number of [[Diagnostic test|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. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Diarrhea is a common symptom of many different disturbances of gut function. It has been estimated that 3–5% of the population will have chronic diarrhea lasting more than 1 month in any given year. In developed countries, the prevalence of chronic diarrhea is estimated to be about 300-500/100,000 person. | Diarrhea is a common symptom of many different disturbances of gut function. It has been estimated that 3–5% of the population will have [[chronic diarrhea]] lasting more than 1 month in any given year. In developed countries, the [[prevalence]] of [[chronic diarrhea]] is estimated to be about 300-500/100,000 person. | ||
==Risk Factors== | ==Risk Factors== | ||
The risk factors of chronic diarrhea can be assessed based on the [[epidemiological]] associations and the patient characteristics .Some of theses factors can be classified based on travel history, [[epidemics]] and [[outbreaks]], [[diabetic]] patients, patients with [[AIDS|acquired immune deficiency syndrome]] and whether the patients are institutionalized or hospitalized. | The [[risk factors]] of [[chronic diarrhea]] can be assessed based on the [[epidemiological]] associations and the patient characteristics .Some of theses factors can be classified based on travel history, [[epidemics]] and [[outbreaks]], [[diabetic]] patients, patients with [[AIDS|acquired immune deficiency syndrome]] and whether the patients are institutionalized or hospitalized. | ||
==Natural History, Complication and Prognosis== | ==Natural History, Complication and Prognosis== | ||
The natural history of chronic diarrhea is [[Watery diarrhea|watery]] or [[Bloody diarrhea|bloody]] or [[fatty stools]] for more than 4 weeks duration. Depending on the underlying cause, chronic or severe diarrhea can lead to potentially serious complications some of which include but are not limited to [[dehydration]] and [[malnutrition]]. The prognosis of chronic diarrhea is good especially when the underlying cause is identified early and treated. | The natural history of [[chronic diarrhea]] is [[Watery diarrhea|watery]] or [[Bloody diarrhea|bloody]] or [[fatty stools]] for more than 4 weeks duration. Depending on the underlying cause, chronic or severe diarrhea can lead to potentially serious complications some of which include but are not limited to [[dehydration]] and [[malnutrition]]. The [[prognosis]] of chronic diarrhea is good especially when the underlying cause is identified early and treated. | ||
==Diagnosis== | ==Diagnosis== | ||
There are no criteria for the diagnosis of chronic diarrhea. However, in order to make an accurate diagnosis, it is important to be able to take a detailed history, physical exam and mostly from expert opinion and from experience in individual clinical centers. The use of these methods are subject to bias however, a specific diagnosis can be achieved in more than 90% of patients. | There are no criteria for the [[diagnosis]] of [[chronic diarrhea]]. However, in order to make an accurate diagnosis, it is important to be able to take a detailed history, physical exam and mostly from expert opinion and from experience in individual clinical centers. The use of these methods are subject to bias however, a specific [[diagnosis]] can be achieved in more than 90% of patients. | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
There are no criteria for the diagnosis of chronic diarrhea. However, in order to make an accurate diagnosis, it is important to be able to take a detailed history, physical exam and mostly from expert opinion and from experience in individual clinical centers. The use of these methods | There are no criteria for the diagnosis of chronic diarrhea. However, in order to make an accurate diagnosis, it is important to be able to take a detailed history, physical exam and mostly from expert opinion and from experience in individual clinical centers. The use of these methods such as osmotic gap can help to classify the chronic diarrhea. A specific diagnosis can be achieved in more than 90% of patients from history and [[physical examination]]. | ||
===Physical Examination=== | ===Physical Examination=== | ||
Some of the physical findings of chronic diarrhea are [[orthostatic hypotension]], [[dehydration]], [[neuropathy]], [[muscle wasting]], [[edema]], [[malnutrition]], [[urticaria]] pigmentosa, [[dermatographism]], pinch [[purpura]], [[macroglossia]], [[hyperpigmentation]], [[Addison's disease|addison’s disease]], migratory necrotizing erythema | Some of the physical findings of [[chronic diarrhea]] are [[orthostatic hypotension]], [[dehydration]], [[neuropathy]], [[muscle wasting]], [[edema]], [[malnutrition]], [[urticaria]] pigmentosa, [[dermatographism]], pinch [[purpura]], [[macroglossia]], [[hyperpigmentation]], [[Addison's disease|addison’s disease]], migratory necrotizing erythema | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
The laboratory findings in chronic diarrhea include [[complete blood count]] to evaluate for [[anemia]], abnormal [[white blood cell count]], [[Electrolyte|electrolytes]], thyroid tests, serological tests for [[celiac disease]] and stool analysis for fecal leukocytes, fecal [[lactoferrin]], [[Fecal occult blood test|fecal occult blood]]. Some other diagnostic studies that have been adopted in the diagnosis of chronic diarrhea include flexible sigmoidoscopy, colonoscopy, esophagogastroduodenoscopy and capsule endoscopy. | The [[laboratory]] findings in [[chronic diarrhea]] include [[complete blood count]] to evaluate for [[anemia]], abnormal [[white blood cell count]], [[Electrolyte|electrolytes]], thyroid tests, serological tests for [[celiac disease]] and [[Stool examination|stool analysis]] for [[Fecal Occult Blood Test|fecal leukocytes]], fecal [[lactoferrin]], [[Fecal occult blood test|fecal occult blood]]. Some other diagnostic studies that have been adopted in the diagnosis of [[chronic diarrhea]] include [[flexible sigmoidoscopy]], [[colonoscopy]], [[esophagogastroduodenoscopy]] and [[capsule endoscopy]]. | ||
===Electrocardiogram=== | ===Electrocardiogram=== | ||
There are no electrocardiogram findings associated with chronic diarrhea. | There are no [[electrocardiogram]] findings associated with [[Chronic diarrhea|chronic diarrhea.]] | ||
===Chest X Ray=== | ===Chest X Ray=== | ||
There are no chest X Ray findings associated with chronic diarrhea. | There are no chest X Ray findings associated with [[chronic diarrhea]]. | ||
===CT Scan=== | ===CT Scan=== | ||
There are no CT findings associated with chronic diarrhea. | There are no CT findings associated with [[chronic diarrhea]]. | ||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
There are no additional imaging findings for chronic diarrhea. | There are no additional imaging findings for [[chronic diarrhea]]. | ||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
Antidiarrheal drugs can be broadly defined as agents that minimize the symptoms of diarrhea by improving stool consistency, reducing stool frequency, or reducing stool weight.<ref name="pmid7605866">{{cite journal| author=Schiller LR| title=Review article: anti-diarrhoeal pharmacology and therapeutics. | journal=Aliment Pharmacol Ther | year= 1995 | volume= 9 | issue= 2 | pages= 87-106 | pmid=7605866 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7605866 }} </ref> | [[Antidiarrheal]] drugs can be broadly defined as agents that minimize the symptoms of [[diarrhea]] by improving stool consistency, reducing stool frequency, or reducing stool weight.<ref name="pmid7605866">{{cite journal| author=Schiller LR| title=Review article: anti-diarrhoeal pharmacology and therapeutics. | journal=Aliment Pharmacol Ther | year= 1995 | volume= 9 | issue= 2 | pages= 87-106 | pmid=7605866 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7605866 }} </ref> The treatment of chronic diarrhea is targeted at treating the underlying cause. | ||
The treatment of chronic diarrhea is targeted at treating the underlying cause. | |||
===Surgery=== | ===Surgery=== | ||
Surgical intervention is not usually recommended for the management of chronic diarrhea. However, depending on the underlying cause, surgery may be required. | [[Surgery|Surgical intervention]] is not usually recommended for the management of [[chronic diarrhea]]. However, depending on the underlying cause, [[surgery]] may be required. | ||
===Prevention=== | ===Prevention=== | ||
There is no established method for the prevention of chronic diarrhea. There are no vaccines for the prevention of the disease | There is no established method for the prevention of [[chronic diarrhea]]. There are no [[vaccines]] for the prevention of the [[disease]]. However, depending on the underlying cause, hand washing and other sanitary processes can be adopted. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 15:24, 25 July 2017
|
Chronic diarrhea Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
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 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. Frequent defecation with normal consistency is termed psuedodiarrhea. There are 3 basic categories of chronic diarrhea: watery, fatty(malabsorption) and inflammatory (with blood and pus). The fundamental pathophysiology of all diarrhea is altered intestinal water and electrolyte transport caused by several factors majorly dependent on the socio-economic status of the population. Treatment is targeted at treating the underlying cause of the diarrhea.
Historical Perspective
The word diarrhea derived from the Greek term "to flow through," is a common manifestation of gastrointestinal disease. Its definition has traditionally been based upon the frequency, volume, and consistency of stools. As a result of various inconsistencies in definition, the American Gastroenterological Association suggests that chronic diarrhea should be defined as a decrease in fecal consistency lasting for four or more weeks.
Classification
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. 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.
Pathophysiology
The fundamental pathophysiology of all diarrhea is incomplete absorption of water from the lumen either because of a reduced rate of net water absorption (related to impaired electrolyte absorption or excessive electrolyte secretion) or because of osmotic retention of water intraluminally. The causes of chronic diarrhea include inflammatory, osmotic, secretory, iatrogenic, motility, and functional diseases. In general, the causes of chronic diarrhea is multifactorial. For example, cholera is caused by secretion and altered motility whereas pseudomembranous colitis is said to be associated with secretion, inflammation, and motility. Thus, diarrhea is a condition of altered intestinal water and electrolyte transport.
Causes
Depending on the socio economic status of the population, chronic diarrhea can be caused by several factors. In a developing nation, the most likely causes of chronic diarrhea are mycobacterial and parasitic infections and less likely to include functional disorders such as malabsorption and inflammatory bowel diseases. In a developed nation however, the most likely cause of diarrhea are irritable bowel syndrome (IBS), inflammatory bowel disease, malabsorption syndromes (such as lactose intolerance and celiac disease), and chronic infections (particularly in patients who are immunocompromised).
Differentiating Chronic Diarrhea from other Conditions
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.
Epidemiology and Demographics
Diarrhea is a common symptom of many different disturbances of gut function. It has been estimated that 3–5% of the population will have chronic diarrhea lasting more than 1 month in any given year. In developed countries, the prevalence of chronic diarrhea is estimated to be about 300-500/100,000 person.
Risk Factors
The risk factors of chronic diarrhea can be assessed based on the epidemiological associations and the patient characteristics .Some of theses factors can be classified based on travel history, epidemics and outbreaks, diabetic patients, patients with acquired immune deficiency syndrome and whether the patients are institutionalized or hospitalized.
Natural History, Complication and Prognosis
The natural history of chronic diarrhea is watery or bloody or fatty stools for more than 4 weeks duration. Depending on the underlying cause, chronic or severe diarrhea can lead to potentially serious complications some of which include but are not limited to dehydration and malnutrition. The prognosis of chronic diarrhea is good especially when the underlying cause is identified early and treated.
Diagnosis
There are no criteria for the diagnosis of chronic diarrhea. However, in order to make an accurate diagnosis, it is important to be able to take a detailed history, physical exam and mostly from expert opinion and from experience in individual clinical centers. The use of these methods are subject to bias however, a specific diagnosis can be achieved in more than 90% of patients.
History and Symptoms
There are no criteria for the diagnosis of chronic diarrhea. However, in order to make an accurate diagnosis, it is important to be able to take a detailed history, physical exam and mostly from expert opinion and from experience in individual clinical centers. The use of these methods such as osmotic gap can help to classify the chronic diarrhea. A specific diagnosis can be achieved in more than 90% of patients from history and physical examination.
Physical Examination
Some of the physical findings of chronic diarrhea are orthostatic hypotension, dehydration, neuropathy, muscle wasting, edema, malnutrition, urticaria pigmentosa, dermatographism, pinch purpura, macroglossia, hyperpigmentation, addison’s disease, migratory necrotizing erythema
Laboratory Findings
The laboratory findings in chronic diarrhea include complete blood count to evaluate for anemia, abnormal white blood cell count, electrolytes, thyroid tests, serological tests for celiac disease and stool analysis for fecal leukocytes, fecal lactoferrin, fecal occult blood. Some other diagnostic studies that have been adopted in the diagnosis of chronic diarrhea include flexible sigmoidoscopy, colonoscopy, esophagogastroduodenoscopy and capsule endoscopy.
Electrocardiogram
There are no electrocardiogram findings associated with chronic diarrhea.
Chest X Ray
There are no chest X Ray findings associated with chronic diarrhea.
CT Scan
There are no CT findings associated with chronic diarrhea.
Other Imaging Findings
There are no additional imaging findings for chronic diarrhea.
Treatment
Medical Therapy
Antidiarrheal drugs can be broadly defined as agents that minimize the symptoms of diarrhea by improving stool consistency, reducing stool frequency, or reducing stool weight.[1] The treatment of chronic diarrhea is targeted at treating the underlying cause.
Surgery
Surgical intervention is not usually recommended for the management of chronic diarrhea. However, depending on the underlying cause, surgery may be required.
Prevention
There is no established method for the prevention of chronic diarrhea. There are no vaccines for the prevention of the disease. However, depending on the underlying cause, hand washing and other sanitary processes can be adopted.
References
- ↑ Schiller LR (1995). "Review article: anti-diarrhoeal pharmacology and therapeutics". Aliment Pharmacol Ther. 9 (2): 87–106. PMID 7605866.