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Diarrhea, Chronic

Sarah A. Turki, MBBS, Stephen M. Testa, MD and Marie L. Borum, MD, EdD, MPH, MACP, FACG, AGAF Reviewed 06/2019
 


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 stool form is the most import...

DIAGNOSIS

HISTORY

  • Detailed history of symptoms (1),(2):

    • Onset, pattern, and frequency of stooling

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

    • Presence of nocturnal symptoms

    • Travel histo...

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:

    • Lactose...

ONGOING CARE

DIET

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

REFERENCES

1
Schiller LR. Definitions, pathophysiology, and evaluation of chronic diarrhoea. Best Pract Res Clin Gastroenterol.  2012;26(5):551–562. [View Abstract on OvidMedline]
2
Schiller LR, Par...

ADDITIONAL READING

  • Camilleri M, Sellin JH, Barrett KE. Pathophysiology, evaluation, and management of chronic watery diarrhea. Gastroenterology.  2017;152(3):515–532.e2. [View Abstract on OvidMed...

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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