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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 bacteria include; [[Mycobacterium|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 include; [[irritable bowel syndrome]] (IBS), [[inflammatory bowel disease]], [[Malabsorption syndrome|malabsorption syndromes]] (such as [[lactose intolerance]] and [[celiac disease]]), and chronic infections (particularly in patients who are [[immunocompromised]]).
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 bacteria include; [[Mycobacterium|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 include; [[irritable bowel syndrome]] (IBS), [[inflammatory bowel disease]], [[Malabsorption syndrome|malabsorption syndromes]] (such as [[lactose intolerance]] and [[celiac disease]]), and chronic infections (particularly in patients who are [[immunocompromised]]).


==Causes==
===Life threatening causes===
===Major causes===
<code>Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.</code>


*'''[[Celiac disease|Malabsorption]]''': Malabsorptive and maldigestive diarrhea result from impaired nutrient absorption and impaired digestive function respectively. [[Cystic fibrosis]], [[celiac disease]], disaccharidase deficiency (eg, [[lactase deficiency]] due to infectious diarrhea), can all cause loss of absorptive capacity. Absent [[pancreatic]] [[enzymes]] or [[Bile acid|bile acids]] can cause maldigestion. Classic symptoms include [[Abdominal distension|abdominal distention]] with foul-smelling, large, floating, pale, fatty stools ([[steatorrhea]]) and [[weight loss]].
There are no life-threatening causes of chronic diaarrhea, however complications resulting from untreated chronic diarrhea is common.
*'''[[Irritable bowel syndrome]]''': Patients present with stool [[mucus]], crampy [[abdominal pain]], altered bowel habits, watery functional diarrhea after meals, exacerbated by emotional stress or eating. It is twice as common in women than men. All laboratory test results are normal. Increased fiber intake, exercise, dietary modification should be recommended.
*[[Inflammatory bowel disease|'''Inflammatory bowel disease''':]]May manifest as either  [[Crohn's disease|crohn disease]] or [[ulcerative colitis]], patients present with bloody inflammatory diarrhea, abdominal pain, nausea, vomiting, loss of appetite, family history, eye findings (e.g., [[episcleritis]]), [[Anal fistula|perianal fistulae]], [[fever]], [[tenesmus]], [[rectal bleeding]], [[weight loss]]. Tests include [[complete blood count]], fecal leukocyte level, [[erythrocyte sedimentation rate]], fecal calprotectin level. Characteristic intestinal [[ulcerations]] are seen on [[colonoscopy]].
* '''[[Microscopic colitis]]''': Patients present with watery, secretory diarrhea affecting older persons. [[Non-steroidal anti-inflammatory drug|Nonsteroidal anti-inflammatory drug]] association is  possible. There is usually no response to fasting; [[nocturnal]] symptoms present. Colon biopsy is recommended.


===Minor causes===
===Common causes===
*'''Gastrointestinal infections'''; such as [[viruses]], [[bacteria]] and [[parasites]].
*'''Non-gastrointestional infections''' (parenteral diarrhea);  systemic infections, staphylococcal toxic shock syndrome, urinary tract infections and other systemic infections.
*'''Anatomic abnormalities'''; Intussusception, hirschsprung disease (± toxic megacolon) partial bowel obstruction, blind loop syndrome (also in patients with dysmotility), Intestinal lymphangiectasis, short gut syndrome.


*[[Immunodeficiency|'''Immunodeficiency''']]; Severe combined immunodeficiencies and other genetic disorders, HIV
*'''[[Celiac disease|Malabsorption]]''':
**[[Cystic fibrosis]],
**C[[celiac disease|eliac disease]],
**Disaccharidase deficiency
*'''[[Irritable bowel syndrome]]'''
*[[Inflammatory bowel disease|'''Inflammatory bowel disease''':]]
**C[[Crohn's disease|rohn disease]]
**Ul[[ulcerative colitis|cerative colitis]],  
* '''[[Microscopic colitis]]'''


*'''Drug-induced diarrhea''': If diarrhea is osmotic consider [[magnesium]], [[phosphates]], [[sulfates]], and [[sorbitol]]. If hypermotility consider stimulant [[laxatives]] or malabsorption [[acarbose]], [[orlistat]]. Elimination of offending agent is often curative.  
*'''Gastrointestinal infections''';
**[[viruses]],
**[[bacteria]]
**[[parasites|Parasites.]]  
*'''Anatomic abnormalities''';
**Intussusception,
**Hirschsprung disease (± toxic megacolon)
**Partial bowel obstruction,
**Blind loop syndrome (also in patients with dysmotility),  
**Intestinal lymphangiectasis,  
**Short gut syndrome.


*'''Endocrine diarrhea''': Secretory diarrhea e,g [[Addison's disease|Addison disease]], [[carcinoid tumors]], [[VIPoma|vipoma]], [[gastrinoma]] ([[Zollinger-Ellison syndrome]]), and [[mastocytosis]]  or increased motility ([[hyperthyroidism]]). Tests that can be ordered include [[thyroid-stimulating hormone]] level, serum peptide concentrations, urinary [[histamine]] level.
*[[Immunodeficiency|'''Immunodeficiency''']];
**Severe combined immunodeficiencies and other genetic disorders,
**HIV
 
*'''Endocrine diarrhea''':  
**[[Addison's disease|Addison disease]],  
**[[carcinoid tumors]],  
**[[VIPoma|Vipoma]],  
**[[gastrinoma]] ([[Zollinger-Ellison syndrome]]),  
**[[mastocytosis]]  or increased motility (
**[[hyperthyroidism]]  


*'''[[Giardiasis]]''': Patients presents with excess gas, [[steatorrhea]] (malabsorption). [[Giardia lamblia infection|Giardia]] fecal antigen test is diagnostic.
*'''[[Giardiasis]]''': Patients presents with excess gas, [[steatorrhea]] (malabsorption). [[Giardia lamblia infection|Giardia]] fecal antigen test is diagnostic.


*'''Infectious enteritis or colitis (diarrhea not associated with C. difficile)''': Examples include [[bacterial gastroenteritis]], [[viral gastroenteritis]], [[amebic dysentery]]. Patients present with inflammatory diarrhea, [[nausea]], [[vomiting]], [[fever]], abdominal pain, a positive history of travel, camping, infectious contacts, day care attendance, increased fecal leukocyte level, elevated erythrocyte sedimentation rate. Cultures or stained fecal smears for specific organisms are more definitive.
*'''Infectious enteritis or colitis (diarrhea not associated with C. difficile)''':  
**[[bacterial gastroenteritis]],  
**[[viral gastroenteritis]],  
**[[amebic dysentery]].  


*'''[[Ischemic colitis]]''':History of [[vascular]] disease and pain associated with eating. [[Colonoscopy]] and  abdominal [[arteriography]] is diagnostic.
*'''[[Ischemic colitis]]'''


*'''Miscellaneous'''; Antibiotic-associated diarrhea, [[pseudomembranous colitis]], toxins, [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]], [[neonatal drug withdrawal]]
*'''Miscellaneous''';  
**Antibiotic-associated diarrhea,  
**[[pseudomembranous colitis]],  
**[[Hemolytic-uremic syndrome|Hemolytic uremic syndrome]],  
**[[neonatal drug withdrawal]]


===Drugs that commonly cause diarrhea<ref name="pmid8614603">{{cite journal| author=Branski D, Lerner A, Lebenthal E| title=Chronic diarrhea and malabsorption. | journal=Pediatr Clin North Am | year= 1996 | volume= 43 | issue= 2 | pages= 307-31 | pmid=8614603 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8614603  }} </ref>===
===Drugs that commonly cause diarrhea<ref name="pmid8614603">{{cite journal| author=Branski D, Lerner A, Lebenthal E| title=Chronic diarrhea and malabsorption. | journal=Pediatr Clin North Am | year= 1996 | volume= 43 | issue= 2 | pages= 307-31 | pmid=8614603 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8614603  }} </ref>===

Revision as of 16:58, 6 July 2017

Chronic diarrhea Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chronic diarrhea from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

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Treatment

Medical Therapy

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Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

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

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 bacteria include; 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 include; 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).

Life threatening causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

There are no life-threatening causes of chronic diaarrhea, however complications resulting from untreated chronic diarrhea is common.

Common causes

  • Gastrointestinal infections;
  • Anatomic abnormalities;
    • Intussusception,
    • Hirschsprung disease (± toxic megacolon)
    • Partial bowel obstruction,
    • Blind loop syndrome (also in patients with dysmotility),
    • Intestinal lymphangiectasis,
    • Short gut syndrome.
  • Immunodeficiency;
    • Severe combined immunodeficiencies and other genetic disorders,
    • HIV

Drugs that commonly cause diarrhea[1]

References

  1. ↑ Branski D, Lerner A, Lebenthal E (1996). "Chronic diarrhea and malabsorption". Pediatr Clin North Am. 43 (2): 307–31. PMID 8614603.

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