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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