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Gastro 2013 APDW/WCOG Shanghai working party report: chronic diarrhea: definition, classification, diagnosis
- Source :
- Journal of gastroenterology and hepatology. 29(1)
- Publication Year :
- 2013
-
Abstract
- Diarrhea is best defined as passage of loose stools often with more frequent bowel movements. For clinical purposes, the Bristol Stool Form Scale works well to distinguish stool form and to identify loose stools. Laboratory testing of stool consistency has lagged behind. Acute diarrhea is likely to be due to infection and to be self-limited. As diarrhea becomes chronic, it is less likely to be due to infection; duration of 1 month seems to work well as a cut-off for chronic diarrhea, but detailed scientific knowledge is missing about the utility of this definition. In addition to duration of diarrhea, classifications by presenting scenario, by pathophysiology, and by stool characteristics (e.g. watery, fatty, or inflammatory) may help the canny clinician refine the differential diagnosis of chronic diarrhea. In this regard, a careful history remains the essential part of the evaluation of a patient with diarrhea. Imaging the intestine with endoscopy and radiographic techniques is useful, and biopsy of the small intestine and colon for histological assessment provides key diagnostic information. Endomicroscopy and molecular pathology are only now being explored for the diagnosis of chronic diarrhea. Interest in the microbiome of the gut is increasing; aside from a handful of well-described infections because of pathogens, little is known about alterations in the microbiome in chronic diarrhea. Serological tests have well-defined roles in the diagnosis of celiac disease but have less clearly defined application in autoimmune enteropathies and inflammatory bowel disease. Measurement of peptide hormones is of value in the diagnosis and management of endocrine tumors causing diarrhea, but these are so rare that these tests are of little value in screening because there will be many more false-positives than true-positive results. Chemical analysis of stools is of use in classifying chronic diarrhea and may limit the differential diagnosis that must be considered, but interpretation of the results is still evolving. Breath tests for assessment of carbohydrate malabsorption, small bowel bacterial overgrowth, and intestinal transit are fraught with technical limitations that decrease sensitivity and specificity. Likewise, tests of bile acid malabsorption have had limited utility beyond empirical trials of bile acid sequestrants.
- Subjects :
- Adult
Aged, 80 and over
Diarrhea
Male
China
Adolescent
Peptide Hormones
Middle Aged
Magnetic Resonance Imaging
Endoscopy, Gastrointestinal
Steatorrhea
Bile Acids and Salts
Feces
Pancreatic Function Tests
Young Adult
Breath Tests
Chronic Disease
Intestine, Small
Humans
Female
Serologic Tests
Tomography, X-Ray Computed
Aged
Subjects
Details
- ISSN :
- 14401746
- Volume :
- 29
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Journal of gastroenterology and hepatology
- Accession number :
- edsair.pmid..........39057a638d5ba24fd86b147a58523a29