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.