Chronic Diarrhea: Diagnosis and Management
Lawrence R Schiller1, Darrell S Pardi2, Joseph H Sellin3
1Department of Internal Medicine, Division of Gastroenterology, Baylor University Medical Center, Dallas, Texas.
Summary
Chronic diarrhea affects up to 5% of people. Evaluation involves history, physical exams, and targeted testing to diagnose causes like irritable bowel syndrome and guide treatment.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Chronic diarrhea affects up to 5% of the population.
- Symptoms include loose stools, increased frequency, urgency, or incontinence.
- Distinguishing chronic from acute diarrhea is based on symptom duration, typically over 4 weeks.
Purpose of the Study:
- To outline the evaluation and diagnosis of chronic diarrhea.
- To differentiate various causes of chronic diarrhea.
- To guide appropriate diagnostic testing and therapeutic strategies.
Main Methods:
- Clinical history and physical examination are primary tools.
- Symptom clusters and patient history can suggest causes like diet, medications, or prior surgery/radiation.
- Diagnostic testing includes blood work, stool analysis, endoscopy, imaging, histology, and physiological tests when indicated.
- Rome criteria aid in distinguishing Irritable Bowel Syndrome (IBS).
Main Results:
- History alone can identify causes like diet, medications, or surgery/radiation.
- Testing is crucial when alarm features are present or the cause is unclear.
- A tiered approach to testing can lead to more directed and rapid diagnosis.
- Empiric antidiarrheal therapy can manage symptoms when specific treatments are unavailable.
Conclusions:
- Chronic diarrhea requires a systematic evaluation.
- History and physical examination are essential for initial assessment.
- Judicious use of diagnostic tests, guided by clinical presentation and alarm features, is key for accurate diagnosis and management.
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