Prognosis of chronic secretory diarrhea

What is the likely outcome in patients with chronic secretory diarrhea in whom a diagnosis cannot be reached? 

  • Diagnostic testing may fail to reveal a cause for chronic diarrhea in up to 25% of patients with chronic diarrhea depending on referral bias and the extent of evaluation. 
  • Some patients with chronic secretory diarrhea that evades a serious diagnostic evaluation have a similar history of previous good health with the sudden onset of diarrhea, often accompanied by acute, but not progressive, weight loss.
  • Although the acute onset suggests an acute infectious process, patients have negative microbiological studies and do not respond to empiric antibiotics.
  • Diarrhea usually persists for 12 to 30 months and then gradually subsides. This condition can be sporadic or can occur in epidemics.
  • The epidemic form (Brainerd’s diarrhea) seems to be associated with ingestion of potentially contaminated food or drink, but no organism has been implicated.
  • Management consists of the effective use of nonspecific antidiarrheals until the process subsides. 
  • In other patients with chronic undiagnosed secretory diarrhea, a diagnosis will become apparent in time.
  • Once a thorough evaluation has been concluded, it is therefore preferable to treat patients with undiagnosed secretory diarrhea symptomatically and follow them at intervals rather than to endlessly repeat diagnostic testing.
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