Chronic diarrhea differential diagnosis
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Chronic diarrhea Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
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.
Differential diagnosis
It is important to differentiate chronic diarrhea based on the kind of diarrhea that is produced. Chronic diarrhea can be subdivided into three major types; watery, fatty, inflammatory. Watery chronic diarrhea can then further be sub-divided into osmotic or secretory diarrhea. Below is a list of differential diagnosis of chronic diarrhea by stool characteristics.[1][2]
Watery
- Secretory (often nocturnal; unrelated to food intake; fecal osmotic gap < 50 mOsm per kg*)
- Alcoholism
- Bacterial enterotoxins (e.g., cholera)
- Bile acid malabsorption
- Brainerd diarrhea (epidemic secretory diarrhea)
- Congenital syndromes
- Crohn disease (early ileocolitis)
- Endocrine disorders e.g., hyperthyroidism
- Medications (see causes section)
- Microscopic colitis (lymphocytic and collagenous subtypes)
- Neuroendocrine tumors (e.g., gastrinoma, vipoma, carcinoid tumors, mastocytosis)
- Nonosmotic laxatives (e.g., senna, docusate sodium)
- Postsurgical (e.g., cholecystectomy, gastrectomy, vagotomy, intestinal resection)
- Vasculitis
- Osmotic (fecal osmotic gap > 125 mOsm per kg*)
- Functional (distinguished from secretory types by hypermotility, smaller volumes, and improvement at night and with fasting)
Fatty (bloating and steatorrhea in many, but not all cases)
- Malabsorption syndrome (damage to or loss of absorptive ability)
- Amyloidosis
- Carbohydrate malabsorption (e.g., lactose intolerance)
- Celiac sprue (gluten enteropathy)–various clinical presentations
- Gastric bypass
- Lymphatic damage (e.g., congestive heart failure, some lymphomas)
- Medications (e.g., orlistat Xenical; inhibits fat absorption, acarbose Precose; inhibits carbohydrate absorption])
- Mesenteric ischemia
- Noninvasive small bowel parasite (e.g., Giardia)
- Postresection diarrhea
- Short bowel syndrome
- Small bowel bacterial overgrowth (> 105 bacteria per mL)
- Tropical sprue
- Whipple disease (Tropheryma whippelii infection)
- Maldigestion (loss of digestive function)
- Hepatobiliary disorders
- Inadequate luminal bile acid
- Loss of regulated gastric emptying
- Pancreatic exocrine insufficiency
Inflammatory or exudative (elevated white blood cell count, occult or frank blood or pus)
- Inflammatory bowel disease Crohn disease (ileal or early Crohn disease may be secretory)
- Diverticulitis
- Ulcerative colitis
- Ulcerative jejunoileitis
- Invasive infectious diseases
- Clostridium difficile (pseudomembranous) colitis–antibiotic history
- Invasive bacterial infections (e.g., tuberculosis, yersiniosis)
- Invasive parasitic infections (e.g., Entamoeba)–travel history
- Ulcerating viral infections (e.g., cytomegalovirus, herpes simplex virus)
- Neoplasia
- Colon carcinoma
- Lymphoma
- Villous adenocarcinoma
- Radiation colitis
References
- ↑ Fine KD, Schiller LR (1999). "AGA technical review on the evaluation and management of chronic diarrhea". Gastroenterology. 116 (6): 1464–86. PMID 10348832.
- ↑ Lacy, Brian E.; Mearin, Fermín; Chang, Lin; Chey, William D.; Lembo, Anthony J.; Simren, Magnus; Spiller, Robin (2016). "Bowel Disorders". Gastroenterology. 150 (6): 1393–1407.e5. doi:10.1053/j.gastro.2016.02.031. ISSN 0016-5085.