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Diarrhea, Chronic

Stephen M. Testa, MD and Marie L. Borum, MD, EdD, MPH Reviewed 06/2018
 


BASICS

DESCRIPTION

  • An increase in frequency of defecation, urgency, or decrease in stool consistency (typically >3 loose stools per day) for >4 weeks (1,2)

    • Abnormal form is the most important de...

DIAGNOSIS

HISTORY

  • Detailed history of symptoms (1,2):

    • Onset, pattern, and frequency

    • Stool volume and quality (including presence of blood or mucus)

    • Presence of nocturnal symptoms

    • Travel history

    • Antibiotic...

TREATMENT

GENERAL MEASURES

  • Volume resuscitation if necessary

  • Electrolyte replacement if indicated

  • If stable, treatment is generally outpatient (2)[C].

MEDICATION

First Line

  • Based on underlying cause:

    • Lacto...

ONGOING CARE

DIET

Abstain from gluten-containing foods, nonabsorbable carbohydrates, lactose-containing products, and food allergens depending on etiology of diarrhea. 
  • Low FODMAP (fermentable oligosacc...

REFERENCES

1
1 Schiller LR. Definitions, pathophysiology, and evaluation of chronic diarrhoea. Best Pract Res Clin Gastroenterol.  2012;26(5):551–562. {L-End} {L-End} [View Abstract on OvidMedl...

ADDITIONAL READING

  • Camilleri M, Sellin JH, Barrett KE. Pathophysiology, evaluation, and management of chronic watery diarrhea. Gastroenterology.  2017;152(3)515–532.e2. {L-End} {L-End} [View A...

SEE ALSO

Algorithm: Diarrhea, Chronic 

CODES

ICD10

K52.9 Noninfective gastroenteritis and colitis, unspecified 

ICD9

787.91 Diarrhea 

SNOMED

236071009 Chronic diarrhea (disorder) 

CLINICAL PEARLS

  • A comprehensive medical history guides the appropriate workup and avoids unnecessary testing.

  • Consider IBS, IBD, malabsorption syndromes (e.g., lactose intolerance), celiac disease, ove...

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