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Diarrhea, Chronic

Marie L. Borum, MD, EdD, MPH, MACP, FACG, AGAF and Ali A. Khan, MD, MPH Reviewed 06/2020
 


BASICS

DESCRIPTION

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

    • Abnormal stool form is the most important ...

DIAGNOSIS

HISTORY

  • Detailed history of symptoms (1):

    • Onset, pattern, and frequency of stooling

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

    • Travel history

    • Antibiotic exposure

    • Dietary patte...

TREATMENT

GENERAL MEASURES

  • Volume resuscitation if necessary

  • Electrolyte replacement as needed

  • If stable, treatment is generally outpatient (1)[C].

MEDICATION

First Line

  • Based on underlying cause:

    • Lactose in...

ONGOING CARE

DIET

  • Elimination diet: avoid gluten-containing foods, nonabsorbable carbohydrates, lactose-containing products, and food allergens depending on etiology of diarrhea.

  • Low FODMAP (fermentable...

REFERENCES

1
Schiller LR, Pardi DS, Sellin JH. Chronic diarrhea: diagnosis and management. Clin Gastroenterol Hepatol.  2017;15(2):182.e3–193.e3.
2
Singh P, Mitsuhashi S, Ballou S, et al. Demographi...

ADDITIONAL READING

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 (i.e., lactose intolerance), celiac disease, ove...

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