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Definition of chronic diarrhea Chronic diarrhea usually refers to diarrhea that lasts more than 4 weeks.
The incidence of chronic diarrhea in China is about 5%
.
Causes of Chronic Diarrhea The causes of chronic diarrhea are diverse and involve a wide spectrum of diseases.
It is not easy to make a timely and correct diagnosis.
Therefore, clinicians need to be familiar with the causes of chronic diarrhea
.
According to the third edition of "Guidelines for the Investigation of Adult Chronic Diarrhea" issued by the British Gastroenterology Society (BSG), common causes of chronic diarrhea include: ➤Irritable bowel syndrome-diarrhea (IBS-D) ), ➤Bile acid diarrhea (BAD), ➤Dietary factors (fermented oligosaccharides, disaccharides, monosaccharides and polyols, malabsorption, lack of lactase, intake of artificial sweeteners, caffeine, excessive Drinking, etc.
) ➤ Colorectal cancer ➤ Inflammatory bowel disease ➤ Celiac disease ➤ Drugs (antibiotics, non-steroidal anti-inflammatory drugs, magnesium preparations, hypoglycemic drugs, anti-tumor drugs, etc.
) ➤ Spilled diarrhea; less common causes Including: ➤ small bowel bacterial overgrowth (SBBO) ➤ mesenteric ischemia ➤ lymphoma ➤ surgical reasons (such as small bowel resection, incontinence, internal fistula, etc.
) ➤ chronic pancreatitis ➤ radiation enteropathy ➤ pancreatic cancer ➤ Hyperthyroidism ➤ Diabetes ➤ Flagellosis (and other chronic infections) ➤ Cystic fibrosis is rare / rare causes include: ➤ Other small bowel diseases (such as Whipple disease, tropical stomatitis, diarrhea, amyloidosis, small intestinal lymphangiectasis) Etc.
) ➤ Hypoparathyroidism ➤ Addison disease ➤ Hormone-secreting tumors (such as vasoactive intestinal peptide tumors, gastrinomas, carcinoids, etc.
) ➤ Autonomic neuropathy ➤ Artificial diarrhea ➤ Brainerd diarrhea (infectious etiology of undetermined Diarrhea) These medical histories may correspond to these causes combined with the above-mentioned causes of chronic diarrhea.
Clinicians should ask the patient's medical history in detail and comprehensively.
Comprehensive medical history can provide clues for the diagnosis of chronic diarrhea..
➤Diarrhea that occurred within 3 months, mainly night diarrhea, with persistent symptoms (relative to intermittent diarrhea), accompanied by obvious weight loss, suggesting that the patient may have an organic disease; ➤ malabsorption is often accompanied by steatorrhea And obviously foul-smelling stool; ➤colon inflammation or secretory diarrhea often manifests as watery stools with blood or mucus; ➤patients with tumors, inflammatory bowel disease, celiac disease, etc.
in the family history are also high-risk groups of the disease; ➤ Pancreatic diseases and some systemic diseases, such as hyperthyroidism and hypothyroidism, diabetes, adrenal diseases, systemic sclerosis, etc.
can also be accompanied by diarrhea; ➤Past resection of the ileum and right colon, and end ileum Those with a history of short-segment resection, cholecystectomy, etc.
may also experience diarrhea due to reduced intestinal absorption area, shortened intestinal transit time, and changes in bile acid pools; ➤Recently applied new drugs (such as metformin, antibiotics or proton pump inhibition) Drugs), etc.
may cause drug-induced diarrhea; ➤In immunosuppressed patients, diarrhea is likely to have infectious factors
.
References: [1]ARASARADNAM RP, BROWN S, FORBES A, et al.
Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition[J].
Gut, 2018, 67(8): 1380-1399.
DOI: 10.
1136/gutjnl-2017-315909.
[2] Zhu Xinying, Zhao Dongqiang.
Interpretation of the 2018 British Society of Gastroenterology "Guidelines for the Investigation of Adult Chronic Diarrhea"[J].
Chinese General Practice.
2021.
24(7): 780-783 .
The incidence of chronic diarrhea in China is about 5%
.
Causes of Chronic Diarrhea The causes of chronic diarrhea are diverse and involve a wide spectrum of diseases.
It is not easy to make a timely and correct diagnosis.
Therefore, clinicians need to be familiar with the causes of chronic diarrhea
.
According to the third edition of "Guidelines for the Investigation of Adult Chronic Diarrhea" issued by the British Gastroenterology Society (BSG), common causes of chronic diarrhea include: ➤Irritable bowel syndrome-diarrhea (IBS-D) ), ➤Bile acid diarrhea (BAD), ➤Dietary factors (fermented oligosaccharides, disaccharides, monosaccharides and polyols, malabsorption, lack of lactase, intake of artificial sweeteners, caffeine, excessive Drinking, etc.
) ➤ Colorectal cancer ➤ Inflammatory bowel disease ➤ Celiac disease ➤ Drugs (antibiotics, non-steroidal anti-inflammatory drugs, magnesium preparations, hypoglycemic drugs, anti-tumor drugs, etc.
) ➤ Spilled diarrhea; less common causes Including: ➤ small bowel bacterial overgrowth (SBBO) ➤ mesenteric ischemia ➤ lymphoma ➤ surgical reasons (such as small bowel resection, incontinence, internal fistula, etc.
) ➤ chronic pancreatitis ➤ radiation enteropathy ➤ pancreatic cancer ➤ Hyperthyroidism ➤ Diabetes ➤ Flagellosis (and other chronic infections) ➤ Cystic fibrosis is rare / rare causes include: ➤ Other small bowel diseases (such as Whipple disease, tropical stomatitis, diarrhea, amyloidosis, small intestinal lymphangiectasis) Etc.
) ➤ Hypoparathyroidism ➤ Addison disease ➤ Hormone-secreting tumors (such as vasoactive intestinal peptide tumors, gastrinomas, carcinoids, etc.
) ➤ Autonomic neuropathy ➤ Artificial diarrhea ➤ Brainerd diarrhea (infectious etiology of undetermined Diarrhea) These medical histories may correspond to these causes combined with the above-mentioned causes of chronic diarrhea.
Clinicians should ask the patient's medical history in detail and comprehensively.
Comprehensive medical history can provide clues for the diagnosis of chronic diarrhea..
➤Diarrhea that occurred within 3 months, mainly night diarrhea, with persistent symptoms (relative to intermittent diarrhea), accompanied by obvious weight loss, suggesting that the patient may have an organic disease; ➤ malabsorption is often accompanied by steatorrhea And obviously foul-smelling stool; ➤colon inflammation or secretory diarrhea often manifests as watery stools with blood or mucus; ➤patients with tumors, inflammatory bowel disease, celiac disease, etc.
in the family history are also high-risk groups of the disease; ➤ Pancreatic diseases and some systemic diseases, such as hyperthyroidism and hypothyroidism, diabetes, adrenal diseases, systemic sclerosis, etc.
can also be accompanied by diarrhea; ➤Past resection of the ileum and right colon, and end ileum Those with a history of short-segment resection, cholecystectomy, etc.
may also experience diarrhea due to reduced intestinal absorption area, shortened intestinal transit time, and changes in bile acid pools; ➤Recently applied new drugs (such as metformin, antibiotics or proton pump inhibition) Drugs), etc.
may cause drug-induced diarrhea; ➤In immunosuppressed patients, diarrhea is likely to have infectious factors
.
References: [1]ARASARADNAM RP, BROWN S, FORBES A, et al.
Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition[J].
Gut, 2018, 67(8): 1380-1399.
DOI: 10.
1136/gutjnl-2017-315909.
[2] Zhu Xinying, Zhao Dongqiang.
Interpretation of the 2018 British Society of Gastroenterology "Guidelines for the Investigation of Adult Chronic Diarrhea"[J].
Chinese General Practice.
2021.
24(7): 780-783 .