What causes of chronic diarrhea may be difficult to diagnose

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 a diagnosis. In general, the tests necessary to make these diagnoses are not difficult, but have not been done because physicians have not considered these diagnoses in the differential diagnosis of chronic diarrhea.

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