From the Guidelines
Chronic diarrhea is defined as the abnormal passage of three or more loose or liquid stools per day for more than four weeks and/or a daily stool weight greater than 200 g/day. This definition is based on the most recent and highest quality study available, which emphasizes the importance of considering both the frequency and consistency of stools, as well as the duration of symptoms, in diagnosing chronic diarrhea 1.
Key Considerations
- The definition of chronic diarrhea is crucial in distinguishing it from acute diarrhea, which typically resolves within a few days.
- Chronic diarrhea can result from various underlying causes, including inflammatory bowel disease, irritable bowel syndrome, celiac disease, microscopic colitis, malabsorption disorders, infections, medication side effects, or endocrine disorders like hyperthyroidism.
- The persistent nature of chronic diarrhea can lead to complications such as dehydration, electrolyte imbalances, malnutrition, and weight loss.
Diagnostic Approach
- Diagnosis typically involves a detailed medical history, physical examination, stool tests, blood work, and possibly endoscopic procedures to identify the underlying cause.
- The initial assessment should direct the clinician to determine whether further investigation is necessary and, if so, whether the focus should be on colonic, small bowel, or pancreatic disease.
Treatment
- Treatment depends on the specific cause but may include dietary modifications, anti-diarrheal medications, antibiotics for infectious causes, or specific treatments for underlying conditions.
- The physiological mechanism behind chronic diarrhea often involves disruption of normal intestinal absorption and secretion processes, leading to excess water content in the stool and increased frequency of bowel movements.
Recent Guidelines
- The 2018 guidelines for the investigation of chronic diarrhea in adults emphasize the importance of a thorough clinical assessment and the use of diagnostic tests to identify underlying causes 1.
- The 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea provide guidance on the evaluation and treatment of infectious causes of diarrhea 1.
- The 2019 AGA technical review on the evaluation of functional diarrhea and diarrhea-predominant irritable bowel syndrome in adults provides guidance on the diagnosis and management of functional diarrhea and IBS-D 1.
From the Research
Definition of Chronic Diarrhea
- Chronic diarrhea is defined as a predominantly loose stool lasting longer than four weeks 2
- It can also be characterized by more than 3 bowel movements per day, or loose stools, or stool weight >200 g/day for at least 4 weeks 3
- The definition of chronic diarrhea is based on the duration of symptoms, with 4 weeks being a frequently used cutoff to distinguish it from acute diarrhea 4
Key Characteristics
- Chronic diarrhea is a complex and common problem with a broad differential diagnosis 5
- It can be caused by various factors, including inflammatory, neoplastic, malabsorptive, infective, vascular, and functional gastrointestinal diseases 3
- Accompanying symptoms may include urgency, abdominal pain, or cramps 3
Diagnostic Approach
- A patient history and physical examination are essential in evaluating chronic diarrhea 2, 4
- Laboratory tests, such as stool studies, blood tests, and imaging studies, may be necessary to categorize diarrhea and determine its cause 2, 4, 3
- The diagnostic approach should be tailored to the individual patient, taking into account their symptoms, medical history, and other factors 4, 3