Definitions, pathophysiology, and evaluation of chronic diarrhoea

Area of Science:

• Gastroenterology
• Clinical Medicine

Background:

• Current definitions for chronic diarrhoea are arbitrary and lack evidence-based support.
• The common four-week duration primarily excludes self-limiting infectious causes.
• Patient perception of diarrhoea often relates to stool consistency or incontinence, not just frequency.

Purpose of the Study:

• To critically evaluate the arbitrary definitions of chronic diarrhoea.
• To highlight the complexity in patient-reported symptoms versus clinical definitions.
• To emphasize the need for precise patient history in diarrhoea evaluation.

Main Methods:

• Review of existing definitions and clinical practices for chronic diarrhoea.
• Analysis of patient-reported symptoms versus established diagnostic criteria.
• Discussion of the complex pathophysiology of diarrhoea, including absorption, secretion, and osmotic factors.

Main Results:

• Established definitions for chronic diarrhoea are not evidence-based.
• Patient descriptions of diarrhoea are subjective and varied.
• Understanding the precise meaning of 'diarrhoea' from the patient's perspective is crucial.

Conclusions:

• Arbitrary definitions of chronic diarrhoea require re-evaluation.
• Physician-led inquiry into patient-specific symptoms is essential for accurate diagnosis.
• An algorithmic approach to evaluating the complex pathophysiology of diarrhoea is feasible and recommended.