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Clinical approach to diarrhea

Internal and Emergency Medicine volume 7, pages 255–262 (2012)Cite this article

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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.

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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

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Authors and Affiliations

  1. Department of Clinical Medicine, Digestive Diseases and Internal Medicine, University of Bologna, St. Orsola-Malpighi Hospital, Bldg #5, ‘Nuove Patologie’, Via Massarenti 9, 40138, Bologna, Italy

    Roberto Corinaldesi, Vincenzo Stanghellini, Giovanni Barbara, Paola Tomassetti & Roberto De Giorgio

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  1. Roberto Corinaldesi
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  2. Vincenzo Stanghellini
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  3. Giovanni Barbara
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  4. Paola Tomassetti
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  5. Roberto De Giorgio
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Correspondence to Roberto Corinaldesi.

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Corinaldesi, R., Stanghellini, V., Barbara, G. et al. Clinical approach to diarrhea. Intern Emerg Med 7 (Suppl 3), 255–262 (2012). https://doi.org/10.1007/s11739-012-0827-4

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Keywords

  • Chronic diarrhea
  • Osmotic diarrhea
  • Secretory diarrhea
  • Steatorrhea