Chronic, Noninfectious Diarrhea: A Review - PubMed
5 hours ago
- #microscopic colitis
- #chronic diarrhea
- #IBS-D
- Chronic diarrhea is defined as loose or watery stools lasting longer than 4 weeks, affecting 6% to 7% of US adults.
- Over 90% of chronic diarrhea cases have noninfectious causes, with IBS-D and functional diarrhea being the most common.
- IBS-D presents with recurrent abdominal pain related to defecation, while functional diarrhea involves frequent loose stools without significant pain.
- Small-bowel causes (e.g., celiac disease, bacterial overgrowth) often lead to large-volume diarrhea, weight loss, and possible steatorrhea.
- Colonic causes (e.g., bile acid diarrhea, microscopic colitis) typically involve frequent, low-volume stools, urgency, or mucus.
- Diagnostic evaluation includes serological tests for celiac disease, fecal calprotectin, and colonoscopy for high-risk patients.
- Microscopic colitis affects 13% of chronic diarrhea cases and requires random biopsies during colonoscopy for diagnosis.
- Lifestyle modifications (e.g., scheduled meals, fluid intake, avoiding caffeine/alcohol) and dietary changes (low-FODMAP diet) are first-line treatments.
- Medications like opiate agonists (loperamide), anticholinergics, and 5-HT3 antagonists (ondansetron) improve symptoms in 50%–80% of patients.