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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 my country 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" published 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 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 such 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 data 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, indicating 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, and celiac disease 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.
may also be accompanied by diarrhea; ➤Past resection of the ileum and right colon, and the end of the ileum Those with a history of short-segment resection, cholecystectomy, etc.
, may also have 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 my country 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" published 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 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 such 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 data 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, indicating 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, and celiac disease 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.
may also be accompanied by diarrhea; ➤Past resection of the ileum and right colon, and the end of the ileum Those with a history of short-segment resection, cholecystectomy, etc.
, may also have 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 .
