What is the best nonspecific therapy for chronic diarrhea? Because the evaluation of chronic diarrhea may extend over several weeks and because the diagnosis is not always forthcoming, patients may need symptomatic therapy. The most effective agents are opiates. Traditional antidiarrheal agents, such as diphenoxylate and loperamide, work well in many patients but should be …
Bile acid diarrhea In patients with ileal resection or disease, the part of the small intestine with high-affinity bile acid transporters has been removed or is dysfunctional. Thus excessive bile acid finds its way into the colon. If the bile acid concentration in colonic contents reaches a critical level of approximately 3 to 5 mmol/L, …
What features should suggest surreptitious laxative ingestion? Some patients who present with chronic diarrhea have diarrhea as a result of laxative abuse. In general, four groups of patients have this diagnosis: Bulimic patients: usually adolescent or young adult women concerned about body weight or with overt eating disorders Patients seeking a secondary gain: disability payments, …
What are common causes of iatrogenic diarrhea? Most iatrogenic diarrheas are due to ingestion of drugs, some of which may not be considered as common causes of diarrhea. Approximately two thirds of the drugs listed in the Physician’s Desk Reference mention diarrhea as a possible side effect. Therefore the physician should obtain a history of all ingested …
What causes of chronic diarrhea may be difficult to diagnose? Fecal incontinence Iatrogenic diarrhea (drugs, surgery, radiation) Surreptitious laxative ingestion Microscopic colitis syndrome Bile acid–induced diarrhea Small bowel bacterial overgrowth Pancreatic exocrine insufficiency Carbohydrate malabsorption Peptide-secreting tumors Chronic idiopathic secretory diarrhea These conditions are seen in referral centers after routine evaluation has failed to disclose …
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How to distinguish irritable bowel syndrome from chronic diarrhea? The diagnosis of irritable bowel syndrome should be based on the presence of abdominal pain that is associated with defecation and abnormal bowel habits. Chronic continuous diarrhea in the absence of pain is not irritable bowel syndrome, although it may be functional in nature. Symptom criteria …
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How is chronic inflammatory diarrhea evaluated Inflammatory diarrheas can be due to idiopathic inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease; invasive chronic infectious diseases, such as tuberculosis or yersiniosis; ischemic colitis; radiation colitis; and some tumors. To sort through these diagnoses, the most appropriate tests include colonoscopy to inspect the colonic mucosa …