Advertisement

Diarrhea pp 431-442 | Cite as

Evaluation of Patients with Diarrhea and Timing of Referral

  • Chami Amaratunge
  • Joseph H. Sellin
Chapter
Part of the Clinical Gastroenterology book series (CG)

Summary

Diarrhea is a universal human experience, that is, a symptom and not a disease (Schiller LR, Sellin JH. Approach to a patient with symptoms and signs: diarrhea. In: Sleisenger and Fordtran’s gastrointestinal and liver disease, 9th edn. Philadelphia, PA: Saunders, Elsevier, 2010, pp. 159–186). Most patients with diarrhea can be managed successfully as outpatients; however, more than 450,000 hospital admissions each year are for gastroenteritis (Schiller LR, Sellin JH. Approach to a patient with symptoms and signs: diarrhea. In: Sleisenger and Fordtran’s gastrointestinal and liver disease, 9th edn. Philadelphia, PA: Saunders, Elsevier, 2010, pp. 159–186). The evaluation of patients with diarrhea is complex. A detailed and carefully taken history is essential to aid in the classification of diarrhea. Appropriately defining and classifying diarrhea is an essential first step that provides the clinician a framework for approaching diagnostic and therapeutic options. There are several methods to classify diarrhea and no single method of classification is ideal. The most frequently used methods of classification are as follows: by time course (acute or chronic), volume (large or small), pathophysiology (secretory or osmotic), stool characteristics (watery, fatty, inflammatory), and/or epidemiology (travel related, immune suppression, epidemic). Based on above classification methods, a rational approach can be used by the primary care physician to further manage patients with diarrhea, including when to consider referral to a gastroenterologist.

Key Words

Diarrhea management Hospitalization Diarrhea therapy Patient referral 

References

  1. 1.
    Schiller LR, Sellin JH. Approach to a patient with symptoms and signs: diarrhea. In: Sleisenger and Fordtran’s gastrointestinal and liver disease. Saunders Elsevier. Philadelphia, PA. 9th edn. 2010, pp. 159–186.Google Scholar
  2. 2.
    Schiller LR, et al. Diarrhea and malabsorption in the elderly. Gastroenterol Clin N Am 2009; 38:481–502.CrossRefGoogle Scholar
  3. 3.
    King CK, et al. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep 2003; 52(RR-16): 1–16.PubMedGoogle Scholar
  4. 4.
    Guarino A, Albano F, Ashkenazi S, Gendrel D, Hoekstra JH, Shamir R, Szajewska H. ESPGHAN/ESPID evidence-based guidelines for the management of acute gastroenteritis in children in Europe. Expert Working Group. J Pediatr Gastroenterol Nutr 2008; 46(5):619–621.PubMedGoogle Scholar
  5. 5.
    Gupta A, Derbes C, Sellin JH. Clinical indications of the use of antineutrophil cytoplasmic antibodies and anti-Saccharomyces cerevisiae antibodies in the evaluation of inflammatory bowel disease at an Academic Medical Center. IBD J 2005; 10:898–902.Google Scholar
  6. 6.
    Sellin J, Unpublished Observations.Google Scholar
  7. 7.
    Konikoff MR, et al. Role of fecal calprotectin as a biomarker of intestinal inflammation in inflammatory bowel disease. Inflamm Bowel Dis 2006; 12(6):524–534.PubMedCrossRefGoogle Scholar
  8. 8.
    Abraham BP, Thirumurthi S. Clinical significance of inflammatory markers. Curr Gastroenterol Rep 2009; 11(5):360–367.PubMedCrossRefGoogle Scholar
  9. 9.
    Fine KD, et al. The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea. Gastrointest Endosc 2000; 51(3):318–326.PubMedCrossRefGoogle Scholar
  10. 10.
    Shah RJ, et al. Usefulness of colonoscopy with biopsy in the evaluation of patients with chronic diarrhea. Am J Gastroenterol 2001; 96:1091–1095.PubMedCrossRefGoogle Scholar
  11. 11.
    ASGE Practice Guideline. Use of Endoscopy in diarrheal illness. Gastrointest Endosc 2006; 54(6):821–822.Google Scholar
  12. 12.
    Hoffman AF, Mangelsdorf DJ, Kliewer SA. Chronic diarrhea due to excessive bile acid synthesis and not defective ileal transport. Clin Gastroenterol Hepatol 2009; 7:1151–1154.CrossRefGoogle Scholar
  13. 13.
    Antal B, et al. The bile acid turnover rate assessed with the 75SeHCAT test is stable in chronic diarrhea but slightly decreased in healthy subjects after a long period of time. Dig Dis Sci 2008; 53:2935–2940.CrossRefGoogle Scholar
  14. 14.
    Fan X, Sellin JH, et al. Review article: small intestinal bacterial overgrowth, bile acid malabsorption and gluten intolerance as possible causes of chronic watery diarrhea. Aliment Pharmacol Ther 2009; 29(10):1069–1077.PubMedCrossRefGoogle Scholar
  15. 15.
    Walters JR, Tasleem AM, Omer OS, et. al. A new mechanism for bile acid diarrhea: defective feedback inhibition of bile acid biosynthesis. Clin Gastroenterol Hepatol 2009;1189–1194.Google Scholar
  16. 16.
    Bratten JR, Spanier J, Jones MP. Lactulose breath testing does not discriminate patients with irritable bowel syndrome from healthy controls. Am J Gastroenterol 2008; 103:958–963.PubMedCrossRefGoogle Scholar
  17. 17.
    Sellin JH, Hart R. Glucose malabsorption associated with rapid intestinal transit. Am J Gastroenterol. 1992;87:584–589.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Chami Amaratunge
    • 1
  • Joseph H. Sellin
    • 2
  1. 1.Ben Taub General Hospital, Division of GastroenterologyBaylor College of MedicineHoustonUSA
  2. 2.Ben Taub General Hospital, Division of GastroenterologyBaylor College of MedicineHoustonUSA

Personalised recommendations