Internal and Emergency Medicine

, Volume 7, Supplement 3, pp 255–262

Clinical approach to diarrhea

  • Roberto Corinaldesi
  • Vincenzo Stanghellini
  • Giovanni Barbara
  • Paola Tomassetti
  • Roberto De Giorgio
SELECTED PAPER – CHRONIC DIARRHOEA

DOI: 10.1007/s11739-012-0827-4

Cite this article as:
Corinaldesi, R., Stanghellini, V., Barbara, G. et al. Intern Emerg Med (2012) 7(Suppl 3): 255. doi:10.1007/s11739-012-0827-4

Abstract

Diarrhea is defined as reduced stool consistency, increased water content and number of evacuations per day. A wide array of causes and pathophysiological mechanisms underlie acute and chronic forms of diarrhea. This review focuses on the major clinical aspects which should aid clinicians to diagnose chronic diarrhea. Clinical history, physical examination and stool evaluation and the predominant stool characteristic, i.e., bloody, watery, and fatty diarrhea, may narrow the differential diagnosis. Although mainly involved in acute diarrhea, many different infectious agents, including bacteria, viruses and protozoa, can be identified in chronic bloody/inflammatory diarrhea by appropriate microbiological tests and colonoscopic biopsy analysis. Osmotic diarrhea can be the result of malabsorption or maldigestion, with a subsequent passage of fat in the stool leading to steatorrhea. Secretory diarrhea is due to an increase of fluid secretion in the small bowel lumen, a mechanism often identified in gastroenteropancreatic neuroendocrine tumors. The evaluation of the fecal osmotic gap may help to characterize whether a chronic diarrhea is osmotic or secretory. Fatty diarrhea (steatorrhea) occurs if fecal fat output exceeds the absorptive/digestive capacity of the intestine. Steatorrhea results from malabsorption or maldigestion states and tests should differentiate between these two conditions. Individualized diagnostic work ups tailored on pathophysiological and clinical features are expected to reduce costs for patients with chronic diarrhea.

Keywords

Chronic diarrhea Osmotic diarrhea Secretory diarrhea Steatorrhea 

Abbreviations

EMA

Endomysial antibodies

FD

Functional diarrhea

IBD

Inflammatory bowel disease

IBS

Irritable bowel syndrome

IBS-C

Constipation predominant irritable bowel syndrome

IBS-D

Diarrhea predominant irritable bowel syndrome

MRI

Magnetic resonance imaging

75SeHCAT

75-Seleniumhomotaurocholic acid

tTG

Tissue transglutaminase

VIP

Vasoactive intestinal polypeptide

Copyright information

© SIMI 2012

Authors and Affiliations

  • Roberto Corinaldesi
    • 1
  • Vincenzo Stanghellini
    • 1
  • Giovanni Barbara
    • 1
  • Paola Tomassetti
    • 1
  • Roberto De Giorgio
    • 1
  1. 1.Department of Clinical Medicine, Digestive Diseases and Internal MedicineUniversity of Bologna, St. Orsola-Malpighi HospitalBolognaItaly

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