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Evaluation of chronic diarrhea
Gregory Juckett1, Rupal Trivedi
1West Virginia University, Morgantown, USA. gjuckett@hsc.wvu.edu
American Family Physician
|November 17, 2011
Summary
Chronic diarrhea, lasting over four weeks, is categorized as watery, fatty (malabsorption), or inflammatory. Effective diagnosis involves classifying the diarrhea type to guide targeted testing and treatment strategies.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Chronic diarrhea is a prevalent and complex clinical condition.
- It significantly impacts patient quality of life and healthcare resource utilization.
Purpose of the Study:
- To outline a practical diagnostic approach for chronic diarrhea.
- To categorize chronic diarrhea into distinct types for effective management.
Main Methods:
- Classification of chronic diarrhea into watery, fatty (malabsorption), and inflammatory subtypes.
- Subdivision of watery diarrhea into osmotic, secretory, and functional categories.
- Identification of key indicators for each diarrhea type, such as irritable bowel syndrome, microscopic colitis, celiac disease, and inflammatory bowel disease.
Main Results:
- Watery diarrhea encompasses functional (e.g., irritable bowel syndrome) and secretory (e.g., microscopic colitis) types.
- Malabsorptive diarrhea presents with steatorrhea or weight loss, with examples including celiac disease and giardiasis.
- Inflammatory diarrhea is marked by blood/pus in stool and elevated fecal calprotectin, often due to infections or inflammatory bowel diseases like ulcerative colitis and Crohn disease.
Conclusions:
- Categorizing chronic diarrhea by type is crucial for efficient diagnosis and treatment.
- This approach narrows diagnostic possibilities, reduces unnecessary investigations, and allows for targeted empiric therapy when appropriate.
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