Biegunka – Diagnostyka i diagnoza

Biegunka
Diagnostyka i diagnoza

Biegunka definiowana jest jako oddawanie ≥3 luźnych lub płynnych stolców na dobę, z podziałem na ostrą (<2 tyg.), przetrwałą (2-4 tyg.) i przewlekłą (>4 tyg.). Diagnostyka rozpoczyna się od szczegółowego wywiadu i badania fizykalnego, uwzględniając charakter stolca, objawy towarzyszące (np. gorączka >38,5°C, krew w stolcu), historię leków, podróży i chorób współistniejących. W ostrych przypadkach u osób immunokompetentnych często nie wymaga się rozległych badań, jednak wskazania do diagnostyki obejmują m.in. biegunkę trwającą >7 dni, ciężkie odwodnienie, podejrzenie zakażenia Clostridioides difficile czy chorób zapalnych jelit. Badania laboratoryjne obejmują morfologię, elektrolity, CRP, badania stolca (posiew, toksyny C. difficile, parazytologia, kalprotektyna), a w diagnostyce przewlekłej dodatkowo testy oddechowe, elastazę trzustkową i badania w kierunku celiakii. Endoskopia (kolonoskopia, gastroskopia) oraz badania obrazowe (CT, MRI, USG) są wskazane przy niejasnej etiologii lub podejrzeniu zmian strukturalnych.

Diagnostyka biegunki

Biegunka (diarrhea) to stan, w którym występują luźne, wodniste stolce, często oddawane częściej niż zazwyczaj. Światowa Organizacja Zdrowia definiuje biegunkę jako oddawanie trzech lub więcej luźnych lub płynnych stolców w ciągu doby lub oddawanie stolców częściej niż normalnie dla danej osoby¹². W zależności od czasu trwania biegunkę klasyfikuje się jako ostrą (trwającą mniej niż 2 tygodnie), przetrwałą (trwającą 2-4 tygodnie) lub przewlekłą (trwającą ponad 4 tygodnie)³⁴. Prawidłowe rozpoznanie przyczyny biegunki jest kluczowe dla wdrożenia odpowiedniego leczenia⁵.

Ocena kliniczna biegunki

Diagnostyka biegunki rozpoczyna się od szczegółowego wywiadu lekarskiego i badania fizykalnego⁶⁷. Lekarz zbiera informacje dotyczące charakterystyki objawów, w tym czasu trwania biegunki, konsystencji stolca, częstości wypróżnień, obecności krwi lub śluzu w stolcu oraz towarzyszących objawów, takich jak gorączka, bóle brzucha, nudności, wymioty czy utrata masy ciała⁸.

Ważnymi elementami wywiadu są również⁹¹⁰:

Historia przyjmowanych leków (szczególnie antybiotyków)
Historia podróży zagranicznych
Kontakt z osobami chorymi
Spożywane pokarmy i płyny
Choroby współistniejące
Wcześniejsze epizody biegunki

Istotne jest również ustalenie, czy biegunka ma charakter biegunki cienkojellitowej czy grubojellitowej, co pomaga w zawężeniu diagnostyki różnicowej¹¹. Badanie fizykalne powinno obejmować ocenę stanu nawodnienia pacjenta, badanie jamy brzusznej oraz badanie per rectum w przypadku podejrzenia krwawienia¹².

Wskazania do badań diagnostycznych

W większości przypadków ostrej biegunki, szczególnie u osób immunokompetentnych, nie ma potrzeby wykonywania szczegółowych badań diagnostycznych, ponieważ choroba zwykle jest samoograniczająca się¹³¹⁴. Jednakże badania diagnostyczne są wskazane w następujących sytuacjach¹⁵¹⁶:

Biegunka utrzymująca się ponad 7 dni
Obecność krwi lub śluzu w stolcu
Silne bóle brzucha lub objawy ostrego brzucha
Gorączka przekraczająca 38,5°C
Cechy ciężkiego odwodnienia lub zaburzenia elektrolitowe
Podejrzenie choroby zapalnej jelit
Podejrzenie zakażenia Clostridioides difficile (w tym przypadku niedawna antybiotykoterapia lub hospitalizacja)
Pacjenci w podeszłym wieku, z obniżoną odpornością lub z chorobami współistniejącymi
Biegunka związana z podróżą
Podejrzenie epidemii biegunki

Badania diagnostyczne w biegunce

Badania laboratoryjne

W diagnostyce biegunki stosuje się różne badania laboratoryjne, w zależności od obrazu klinicznego i podejrzenia przyczyny¹⁷. Do najczęściej zlecanych badań należą:

Badania krwi – mogą wskazywać na przyczynę biegunki lub jej powikłania¹⁸¹⁹:

Morfologia krwi (CBC) – do oceny obecności anemii, leukocytozy (wskazującej na zakażenie) lub niedożywienia
Elektrolity – do wykrycia zaburzeń elektrolitowych (sód, potas, chlorki, magnez)
Mocznik i kreatynina – do oceny funkcji nerek i stopnia odwodnienia
Białko C-reaktywne (CRP) – marker stanu zapalnego
Badania w kierunku celiakii (przeciwciała przeciwko transglutaminazie tkankowej IgA, całkowite IgA)
Badania funkcji tarczycy
Badania funkcji wątroby

Badania stolca

Badania stolca są kluczowe w diagnostyce biegunki, szczególnie w przypadku podejrzenia przyczyny infekcyjnej²⁰²¹:

Posiew stolca – w celu identyfikacji bakterii chorobotwórczych, takich jak Salmonella, Shigella, Campylobacter, Yersinia enterocolitica czy enteropatogenne szczepy E. coli
Badania w kierunku toksyn Clostridioides difficile – szczególnie u pacjentów po antybiotykoterapii lub hospitalizacji
Badanie parazytologiczne kału – w poszukiwaniu pasożytów (Giardia lamblia, Entamoeba histolytica, Cryptosporidium) i ich jaj
Badania w kierunku wirusów – rotawirusy, norowirusy, adenowirusy
Kał na krew utajoną – wykrywanie ukrytych krwawień z przewodu pokarmowego
Kalprotektyna kałowa – marker stanu zapalnego w jelitach, pomocny w różnicowaniu organicznych (np. nieswoiste zapalenia jelit) i czynnościowych przyczyn biegunki
Badanie pH i osmolalności stolca – do różnicowania biegunki osmotycznej i sekrecyjnej
Badanie elastazy trzustkowej – do diagnostyki niewydolności zewnątrzwydzielniczej trzustki
Test na obecność kwasów żółciowych – przy podejrzeniu biegunki spowodowanej zaburzeniami wchłaniania kwasów żółciowych

W nowoczesnej diagnostyce biegunki coraz częściej stosowane są kompleksowe panele molekularne do jednoczesnego wykrywania wielu patogenów jelitowych, co znacząco skraca czas diagnostyki²²²³²⁴.

Testy oddechowe

Testy oddechowe są przydatne w diagnostyce niektórych przyczyn biegunki²⁵²⁶:

Wodorowy test oddechowy – służy do diagnozowania nietolerancji laktozy, fruktozy, sacharozy oraz zespołu przerostu bakteryjnego jelita cienkiego (SIBO)
Test z kwasem 13C-oktanowym – do oceny czasu opróżniania żołądka

Badania endoskopowe

Badania endoskopowe są wskazane w przypadku biegunki przewlekłej, krwawej lub biegunki o niejasnej etiologii, gdy wcześniejsze badania nie dały rozpoznania²⁷²⁸:

Kolonoskopia – umożliwia ocenę błony śluzowej jelita grubego i pobranie wycinków do badania histopatologicznego. Jest szczególnie przydatna w diagnostyce nieswoistych zapaleń jelit, mikroskopowego zapalenia jelita grubego, nowotworów i infekcji.
Sigmoidoskopia – badanie ograniczone do dolnej części jelita grubego, mniej inwazyjne niż pełna kolonoskopia.
Gastroskopia (ezofagogastroduodenoskopia) – badanie górnego odcinka przewodu pokarmowego, pozwalające na ocenę żołądka i dwunastnicy oraz pobranie wycinków do diagnostyki chorób takich jak celiakia.
Enteroskopia dwubalonowa – umożliwia ocenę jelita cienkiego, które jest trudno dostępne w standardowych badaniach endoskopowych.

Podczas badań endoskopowych rutynowo pobiera się wycinki błony śluzowej do badania histopatologicznego, co pozwala na wykrycie zmian mikroskopowych, takich jak mikroskopowe zapalenie jelita grubego (colitis microscopica) czy celiakia²⁹³⁰.

Badania obrazowe

Badania obrazowe mogą być pomocne w diagnostyce biegunki, szczególnie gdy podejrzewa się zmiany strukturalne w obrębie przewodu pokarmowego³¹³²:

Tomografia komputerowa (CT) jamy brzusznej – pozwala na ocenę narządów jamy brzusznej i miednicy, wykrycie pogrubienia ściany jelita, niedrożności, zmian nowotworowych, wodobrzusza czy limfadenopatii.
Rezonans magnetyczny (MRI) jamy brzusznej – szczególnie przydatny w diagnostyce chorób zapalnych jelit, bez narażenia na promieniowanie jonizujące.
Ultrasonografia jamy brzusznej – nieinwazyjna metoda oceny narządów jamy brzusznej, przydatna w wykrywaniu patologii pęcherzyka żółciowego, trzustki, wątroby czy obecności wolnego płynu w jamie otrzewnej.
Enterokliza lub pasaż jelita cienkiego – badania radiologiczne z użyciem kontrastu, umożliwiające ocenę struktury i funkcji jelita cienkiego.
Defekografia – badanie radiologiczne oceniające struktury miednicy mniejszej i mechanizm defekacji.

Inne metody diagnostyczne

W diagnostyce biegunki stosuje się również inne metody³³³⁴:

Testy eliminacyjne diety – polegają na czasowym usunięciu z diety potencjalnych alergenów lub pokarmów wywołujących nietolerancję, a następnie ich ponownym wprowadzaniu w celu identyfikacji produktów wywołujących objawy.
Kapsułka endoskopowa – małe urządzenie zawierające miniaturową kamerę, które po połknięciu rejestruje obrazy z całego przewodu pokarmowego.
System monitorowania przewodu pokarmowego SmartPill – kapsułka z wbudowanym systemem bezprzewodowym, rejestrująca poziomy kwasu, temperaturę i zmiany ciśnienia w przewodzie pokarmowym.

Diagnostyka różnicowa biegunki

Biegunka ostra

Najczęstszymi przyczynami ostrej biegunki są³⁵³⁶:

Infekcje wirusowe – rotawirusy, norowirusy, adenowirusy, astrowirusy
Infekcje bakteryjne – Salmonella, Shigella, Campylobacter, enterotoksyczna E. coli, Clostridioides difficile
Infekcje pasożytnicze – Giardia lamblia, Cryptosporidium, Entamoeba histolytica
Zatrucia pokarmowe – toksyny bakteryjne (Staphylococcus aureus, Bacillus cereus, Clostridium perfringens)
Biegunka poantybiotykowa – związana z zaburzeniem naturalnej flory jelitowej
Działania niepożądane leków – antybiotyki, leki przeczyszczające, suplementy magnezu, leki przeciwdepresyjne, NLPZ, chemioterapeutyki

Diagnostyka różnicowa ostrej biegunki opiera się głównie na wywiadzie, badaniu fizykalnym i badaniach laboratoryjnych. W przypadku ostrej biegunki z towarzyszącą gorączką i obecnością krwi w stolcu, należy rozważyć bakteryjne zakażenie jelitowe wymagające posiewu stolca³⁷.

Biegunka przewlekła

Przewlekła biegunka może być klasyfikowana jako³⁸³⁹:

Wodnista – związana z zaburzeniami sekrecji lub motoryki jelitowej
Tłuszczowa – wynikająca z zespołów złego wchłaniania
Zapalna – charakteryzująca się obecnością leukocytów, laktoferyny, kalprotektyny lub krwi w stolcu

Do najczęstszych przyczyn przewlekłej biegunki zalicza się⁴⁰⁴¹:

Zespół jelita drażliwego z biegunką (IBS-D)
Nieswoiste zapalenia jelit (choroba Leśniowskiego-Crohna, wrzodziejące zapalenie jelita grubego)
Mikroskopowe zapalenie jelita grubego (zapalenie kolagenowe, zapalenie limfocytarne)
Celiakia
Nietolerancje pokarmowe (nietolerancja laktozy, fruktozy)
Niewydolność zewnątrzwydzielnicza trzustki
Zespół rozrostu bakteryjnego jelita cienkiego (SIBO)
Zaburzenia wchłaniania kwasów żółciowych
Nowotwory przewodu pokarmowego
Przewlekłe zakażenia pasożytnicze
Endokrynopatie (nadczynność tarczycy, cukrzyca)
Biegunka czynnościowa

Diagnostyka różnicowa przewlekłej biegunki jest złożona i wymaga systematycznego podejścia. Brytyjskie Towarzystwo Gastroenterologiczne zaleca rozpoczęcie od badań przesiewowych wykluczających niedokrwistość, celiakię oraz stan zapalny (kalprotektyna kałowa), a następnie w zależności od wyników tych badań, dalsze postępowanie diagnostyczne⁴²⁴³.

Algorytm diagnostyczny

Amerykańskie Towarzystwo Gastroenterologiczne (AGA) zaleca następujące podejście do diagnostyki przewlekłej biegunki⁴⁴⁴⁵:

Wykonanie badań przesiewowych w kierunku stanu zapalnego (kalprotektyna kałowa lub laktoferyna kałowa)
Badania w kierunku zakażenia Giardia lamblia
Testy w kierunku celiakii (przeciwciała przeciwko transglutaminazie tkankowej IgA oraz badanie stężenia całkowitego IgA)
W przypadku podejrzenia biegunki tłuszczowej – badanie elastazy trzustkowej
Kolonoskopia z pobraniem wycinków z prawej i lewej części okrężnicy (nie z odbytnicy) w celu wykluczenia mikroskopowego zapalenia jelita grubego

Zaproponowany przez AGA algorytm diagnostyczny pozwala na efektywne różnicowanie pomiędzy zespołem jelita drażliwego z biegunką a innymi przyczynami przewlekłej biegunki, takimi jak niewydolność zewnątrzwydzielnicza trzustki⁴⁶.

Szczególne sytuacje kliniczne

Biegunka podróżnych

Biegunka podróżnych (Travelers’ Diarrhea) to zaburzenie jelitowe, które dotyka osoby podróżujące, szczególnie do regionów o niższym standardzie sanitarno-higienicznym⁴⁷. Diagnostyka biegunki podróżnych obejmuje:

Szczegółowy wywiad dotyczący miejsca i czasu podróży, spożywanych pokarmów i napojów
Badanie stolca w kierunku patogenów bakteryjnych, wirusowych i pasożytniczych
W przypadku biegunki przetrwałej (>14 dni) – badanie w kierunku Clostridioides difficile, pasożytów jelitowych oraz rozważenie kolonoskopii

Warto podkreślić, że diagnostyka nie jest zalecana w większości przypadków niepowikłanej biegunki podróżnych, która zwykle ustępuje samoistnie⁴⁸.

Biegunka u pacjentów z obniżoną odpornością

U pacjentów z obniżoną odpornością (np. zakażenie HIV, leczenie immunosupresyjne, chemioterapia) diagnostyka biegunki powinna być bardziej agresywna⁴⁹. Należy rozważyć szerszy panel badań w kierunku patogenów oportunistycznych, takich jak:

Cryptosporidium
Cyclospora
Cystoisospora
Mikrosporydia
Kompleks Mycobacterium avium
Cytomegalowirus

W tej grupie pacjentów zaleca się wczesne wykonanie kolonoskopii z pobraniem wycinków do badania histopatologicznego⁵⁰.

Biegunka u dzieci

Diagnostyka biegunki u dzieci uwzględnia specyfikę tej grupy wiekowej⁵¹. Szczególnej uwagi wymagają:

Stan nawodnienia dziecka
Obecność objawów alarmowych (wysoka gorączka, krwisty stolec, wymioty, objawy neurologiczne)
Różnicowanie z potencjalnie zagrażającymi życiu stanami, takimi jak wgłobienie, krwotoczne zapalenie jelita grubego, zespół hemolityczno-mocznicowy

W diagnostyce biegunki u dzieci ważne jest wykluczenie chorób mogących prowadzić do poważnych powikłań, jednak podobnie jak u dorosłych, większość przypadków ostrej biegunki ma podłoże wirusowe i nie wymaga szczegółowej diagnostyki⁵².

Rodzaj biegunki	Badania pierwszego rzutu	Badania dodatkowe	Kiedy rozważyć badania endoskopowe
Ostra biegunka (<2 tygodnie)	– Morfologia krwi – Elektrolity – CRP – Posiew stolca (w przypadku krwistej biegunki lub ciężkiego przebiegu)	– Badanie w kierunku toksyn C. difficile (po antybiotykoterapii) – Badanie kału na pasożyty (w przypadku podróży)	– Utrzymujące się objawy pomimo leczenia – Podejrzenie choroby zapalnej jelit – Biegunka krwista o niejasnej etiologii
Biegunka przetrwała (2-4 tygodnie)	– Morfologia krwi – Elektrolity, mocznik, kreatynina – CRP – Posiew stolca – Badanie w kierunku C. difficile – Badanie kału na pasożyty	– Badania w kierunku celiakii – Badania tarczycowe – Kalprotektyna kałowa	– Nieprawidłowe wyniki badań laboratoryjnych – Podejrzenie choroby zapalnej lub czynnościowej jelit
Biegunka przewlekła (>4 tygodnie)	– Morfologia krwi – Elektrolity, mocznik, kreatynina – CRP – Badania w kierunku celiakii – Kalprotektyna kałowa – Badanie w kierunku Giardia – Badanie kału na pasożyty	– Testy oddechowe (nietolerancja laktozy, SIBO) – Elastaza trzustkowa – Badania tarczycowe – Testy eliminacyjne diety – Badania w kierunku kwasów żółciowych	– U większości pacjentów z przewlekłą biegunką – Szczególnie przy obecności: krwi w stolcu, utraty masy ciała, niedokrwistości, podwyższonej kalprotektyny kałowej

Postępowanie terapeutyczne w zależności od wyników diagnostyki

Leczenie biegunki zależy od jej przyczyny, którą ustalamy w procesie diagnostycznym⁵³⁵⁴:

Biegunka infekcyjna – w zależności od patogenu może wymagać antybiotykoterapii (bakterie), leków przeciwpasożytniczych lub przeciwwirusowych
Biegunka poantybiotykowa – odstawienie antybiotyku, jeśli to możliwe, lub zmiana na inny; w przypadku zakażenia C. difficile – wankomycyna, fidaksomycyna lub metronidazol
Zespół jelita drażliwego – leczenie objawowe, modyfikacja diety, leki przeciwbiegunkowe, środki rozkurczowe, leki modulujące mikrobiotę jelitową
Nieswoiste zapalenia jelit – leki przeciwzapalne, immunosupresyjne, biologiczne
Celiakia – dieta bezglutenowa
Nietolerancja laktozy – dieta bezlaktozowa, enzymy laktazy
Niewydolność zewnątrzwydzielnicza trzustki – suplementacja enzymów trzustkowych
Zaburzenia wchłaniania kwasów żółciowych – żywice wiążące kwasy żółciowe (cholestyramina)

Niezależnie od przyczyny, podstawowym elementem leczenia biegunki jest nawodnienie i uzupełnienie elektrolitów, czy to drogą doustną, czy w przypadkach ciężkiego odwodnienia – dożylną⁵⁵⁵⁶.

Kiedy należy skonsultować się z lekarzem

Większość przypadków ostrej biegunki ustępuje samoistnie bez interwencji medycznej⁵⁷. Jednakże konsultacja lekarska jest zalecana w następujących sytuacjach⁵⁸⁵⁹⁶⁰:

Biegunka utrzymująca się ponad 2-3 dni u dorosłych, lub 24 godziny u dzieci
Objawy odwodnienia (suchość błon śluzowych, zmniejszenie ilości moczu, zawroty głowy)
Gorączka przekraczająca 38,5°C
Silny ból brzucha
Obecność krwi lub śluzu w stolcu
Czarny, smolisty stolec
Wymioty uniemożliwiające przyjmowanie płynów
Objawy neurologiczne (splątanie, senność)
Biegunka u osób z obniżoną odpornością, chorobami przewlekłymi lub w podeszłym wieku
Biegunka u niemowląt i małych dzieci
Biegunka występująca po powrocie z podróży zagranicznej
Nagła utrata masy ciała

Prawidłowa i wczesna diagnostyka biegunki pozwala na wdrożenie odpowiedniego leczenia, co z kolei przyczynia się do szybszego ustąpienia objawów i zapobiega powikłaniom⁶¹.

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Materiały źródłowe

#1 Diarrhea – Wikipedia
https://en.wikipedia.org/wiki/Diarrhea
Diarrhea is defined by the World Health Organization as having three or more loose or liquid stools per day, or as having more stools than is normal for that person. […] Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days, by World Gastroenterology Organization. […] A severity score is used to aid diagnosis in children. […] When diarrhea lasts for more than four weeks a number of further tests may be recommended including: Complete blood count and a ferritin if anemia is present, Thyroid stimulating hormone, Tissue transglutaminase for celiac disease, Fecal calprotectin to exclude inflammatory bowel disease, Stool tests for ova and parasites as well as for Clostridioides difficile, A colonoscopy or fecal immunochemical testing for cancer, including biopsies to detect microscopic colitis, Testing for bile acid diarrhea with SeHCAT, 7-hydroxy-4-cholesten-3-one or fecal bile acids depending on availability, Hydrogen breath test looking for lactose intolerance, Further tests if immunodeficiency, pelvic radiation disease or small intestinal bacterial overgrowth suspected. […] A 2019 guideline recommended that testing for ova and parasites was only needed in people who are at high risk though they recommend routine testing for giardia.
#2
https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease
Diarrhoea is defined as the passage of 3 or more loose or liquid stools per day (or more frequent passage than is normal for the individual). […] Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. […] Diarrhoea should be treated with oral rehydration solution (ORS), a solution of clean water, sugar and salt. […] Diarrhoea is a leading cause of malnutrition in children under 5 years old. […] Diarrhoea is a symptom of infections caused by a host of bacterial, viral and parasitic organisms, most of which are spread by faeces-contaminated water. […] Diarrhoea is a leading cause of malnutrition in children under 5 years old. […] Key measures to treat diarrhoea include the following. […] Consulting a health professional, in particular for management of persistent diarrhoea or when there is blood in stool or if there are signs of dehydration.
#3 Diarrheal Diseases â Acute & Chronic | ACG
https://gi.org/topics/diarrhea-acute-and-chronic/
Diarrheal diseases overview: Acute diarrhea is one of the most commonly reported illnesses in the United States, second only to respiratory infections. Worldwide, it is a leading cause of mortality in children younger than four years old, especially in the developing world. Diarrhea that lasts less than 2 weeks is termed acute diarrhea. Persistent diarrhea lasts between 2 and 4 weeks. Chronic diarrhea lasts longer than 4 weeks. […] Symptoms: Diarrheal stools are those that take shape of the container, so they are often described as loose or watery. Some people consider diarrhea as an increase in the number of stools, but stool consistency is really the hallmark. Associated symptoms can include abdominal cramps fever, nausea, vomiting, fatigue and urgency. Chronic diarrhea can be accompanied by weight loss, malnutrition, abdominal pain or other symptoms of the underling illness.
#4 Diarrhea: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/4108-diarrhea
Diarrhea means having a loose, watery stool during a bowel movement. If it doesn’t improve or if you’re experiencing other symptoms like a fever or bloody stool, reach out to a provider to get the treatment (and relief) you need. […] Diarrhea is usually mild (only a few bathroom trips a day) and goes away within a few days. […] Sometimes, though, diarrhea is a sign of a serious condition. […] Diarrhea goes by different names depending on how long it lasts: Acute diarrhea is loose, watery diarrhea that lasts one to two days. […] Chronic diarrhea lasts more than four weeks or comes and goes regularly over a long period. […] The main cause of diarrhea is a virus that infects your gut (gastroenteritis). […] Pathogens (viruses, bacteria and parasites) can all cause infections that lead to diarrhea.
#5 Lab-Tested Diagnosis Needed When Treating Patients with Persistent Diarrhea | Newswise
https://www.newswise.com/articles/lab-tested-diagnosis-needed-when-treating-patients-with-persistent-diarrhea
Persistent diarrhea, which is diarrhea that lasts at least 14 days, is an illness typically caused by parasites or bacteria and requires accurate diagnosis in order to determine what treatment to give, according to Herbert L. DuPont, M.D., director of the Center for Infectious Diseases at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health. […] It is common for doctors not to focus on how many days their patients have had diarrhea, he added. […] For acute diarrhea, the lab has a minimal role, restricted to patients passing bloody stools. If a patient has had diarrhea for two weeks or more, the doctor should focus on the cause of the disease through laboratory testing, with an emphasis on parasites, DuPont said. […] Diagnosis is critical when treating persistent diarrhea, DuPont said. […] Antimicrobial therapy can be useful for many patients with persistent diarrhea, but a lab-established diagnosis is necessary for treatment, according to DuPont.
#6 Diarrhea – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/diarrhea/diagnosis-treatment/drc-20352246
Your healthcare professional will likely ask about your medical history, review the medicines you take and conduct a physical exam. Your health professional may order tests to determine what’s causing your diarrhea. Possible tests include: […] A complete blood count, measurement of electrolytes and tests of kidney function can help indicate how bad your diarrhea is. […] You may have a stool test to see if a bacterium or parasite is causing your diarrhea. […] This type of test can help determine if you have a lactose intolerance. […] Using a thin, lighted tube that’s inserted into the rectum, a medical professional can see inside of the colon. […] A medical professional uses a long, thin tube with a camera on the end to examine the stomach and upper small intestine. […] If you’ve tried lifestyle changes and home remedies for diarrhea without success, your healthcare professional might recommend medicines or other treatments.
#7 Acute Diarrhea in Adults | AAFP
https://www.aafp.org/pubs/afp/issues/2014/0201/p180.html
Acute diarrhea in adults is a common problem encountered by family physicians. The most common etiology is viral gastroenteritis, a self-limited disease. […] A history and physical examination evaluating for risk factors and signs of inflammatory diarrhea and/or severe dehydration can direct any needed testing and treatment. Most patients do not require laboratory workup, and routine stool cultures are not recommended. […] Diagnostic investigation should be reserved for patients with severe dehydration or illness, persistent fever, bloody stool, or immunosuppression, and for cases of suspected nosocomial infection or outbreak. […] In patients with acute diarrhea, stool cultures should be reserved for grossly bloody stool, severe dehydration, signs of inflammatory disease, symptoms lasting more than three to seven days, immunosuppression, and suspected nosocomial infections.
#8 Common Causes of Diarrhea
https://www.webmd.com/digestive-disorders/digestive-diseases-diarrhea
Your doctor will ask about your medical history, what medications you take, and what youve eaten or had to drink recently. They will give you a physical exam to look for signs of dehydration or belly pain. […] Certain tests can help pinpoint the cause of your diarrhea, including: […] Blood tests to look for specific diseases or disorders […] A colonoscopy, in rare cases, in which your doctor looks inside your colon with a thin, flexible tube that holds a tiny camera and light. They can also use this device to take a small sample of tissue. Or your doctor might need to do only a sigmoidoscopy, which looks at just the lower colon. […] Stool tests to look for bacteria or parasites […] An endoscopy to check your stomach and intestines to make sure there aren’t any growths or problems like ulcers that could be causing your diarrhea
#9 Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition | Gut
https://gut.bmj.com/content/67/8/1380
We recommend a careful detailed history to plan investigations (Grade of evidence level 1, Strength of recommendation strong). […] We recommend screening blood tests for the exclusion of anaemia, coeliac disease, etc as well as stool tests for inflammation (Grade of evidence level 1, Strength of recommendation strong). […] We recommend making a positive diagnosis of irritable bowel syndrome (IBS) following basic blood and stool screening tests (Grade of evidence level 2, Strength of recommendation strong). […] We recommend excluding colorectal cancer in those with altered bowel habitrectalbleeding by colonoscopy (Grade of evidence level 1, Strength of recommendation strong). […] Faecal calprotectin is recommended to exclude colonic inflammation in those suspected with IBS and under the age of 40 (Grade of evidence level 1, Strength of recommendation strong).
#10 Approach to the adult with acute diarrhea in resource-abundant settings – UpToDate
https://www.uptodate.com/contents/approach-to-the-adult-with-acute-diarrhea-in-resource-abundant-settings
Approach to the adult with acute diarrhea in resource-abundant settings […] Diarrheal disease is a leading cause of death worldwide. Among adults in resource-abundant settings, diarrhea is often a „nuisance disease” in the healthy individual. […] Most cases of acute diarrhea in adults are of infectious etiology, and most cases resolve with symptomatic treatment alone. When clinicians care for adults with diarrhea, two important decision points are when to perform stool testing and whether to initiate empiric antimicrobial therapy. […] The evaluation of persistent and chronic diarrhea, which is often of a noninfectious etiology, and specific causes of acute diarrhea and chronic diarrhea are discussed separately. […] Diarrhea is defined as the passage of loose or watery stools, typically at least three times in a 24-hour period. It reflects increased water content of the stool, whether due to impaired water absorption and/or active water secretion by the bowel.
#11 Diagnostic approach to chronic diarrhea in dogs and cats (Proceedings)
https://www.dvm360.com/view/diagnostic-approach-chronic-diarrhea-dogs-and-cats-proceedings
Chronic diarrhea is a common problem in dogs and cats. Diagnosis can be difficult and challenging for veterinarians due to the large number of possible causes of chronic diarrhea. Following a logical and thorough diagnostic plan is essential to efficiently arrive at an accurate diagnosis. This seminar will review the author’s approach to the diagnosis of chronic diarrhea. […] Specific information should be obtained describing and characterizing the diarrhea. […] Based on a thorough history, the initial step in evaluation of dogs and cats with chronic diarrhea is to determine if diarrhea is of small bowel, large bowel, or mixed bowel origin. […] This initial distinction between small and large bowel is extremely important because the diagnostic plans and differential diagnoses are different.
#12 Diarrhea – Gastrointestinal Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/gastrointestinal-disorders/symptoms-of-gastrointestinal-disorders/diarrhea
Diarrhea is defined as stool weight 200 g/day. […] Frequent passage of small volumes of stool, as may occur in patients with tenesmus (rectal urgency), should be distinguished from diarrhea. […] Diarrhea can cause a marked worsening of fecal incontinence. […] Complications may result from diarrhea of any etiology. […] Fluid loss with consequent dehydration, electrolyte loss (sodium, potassium, magnesium, chloride), and even vascular collapse sometimes occur. […] Bicarbonate loss can cause metabolic acidosis. […] Hypokalemia can occur when patients have severe or chronic diarrhea or if the stool contains excess mucus. […] Diarrhea occurs when unabsorbable, water-soluble solutes remain in the bowel and retain water. […] Diarrhea occurs when the bowels secrete more electrolytes and water than they absorb.
#13 Diarrhea: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/4108-diarrhea
The most common cause of diarrhea in adults is the norovirus that causes gastroenteritis. […] Diarrhea is a common medication side effect. […] Diarrhea is a common symptom of conditions that cause irritation and inflammation in your bowels (intestines). […] Severe cases of diarrhea may signal a medical condition, like a serious infection, that won’t get better without treatment from a healthcare provider. […] Contact your provider if you have diarrhea with fever, severe pain, vomiting, blood or mucus in your stool, or weight loss. […] Dehydration is one of the biggest concerns with diarrhea. […] Most cases of diarrhea don’t require a diagnosis or treatment. […] In more severe cases, your provider will work to determine the cause. […] They may order tests, including blood tests to rule out certain conditions that cause diarrhea.
#14 Acute Diarrhea in Adults | AAFP
https://www.aafp.org/pubs/afp/issues/2014/0201/p180.html
Acute diarrhea in adults is a common problem encountered by family physicians. The most common etiology is viral gastroenteritis, a self-limited disease. […] A history and physical examination evaluating for risk factors and signs of inflammatory diarrhea and/or severe dehydration can direct any needed testing and treatment. Most patients do not require laboratory workup, and routine stool cultures are not recommended. […] Diagnostic investigation should be reserved for patients with severe dehydration or illness, persistent fever, bloody stool, or immunosuppression, and for cases of suspected nosocomial infection or outbreak. […] In patients with acute diarrhea, stool cultures should be reserved for grossly bloody stool, severe dehydration, signs of inflammatory disease, symptoms lasting more than three to seven days, immunosuppression, and suspected nosocomial infections.
#15 IDSA 2017 Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea
https://www.idsociety.org/practice-guideline/infectious-diarrhea/
These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. […] Summarized below are recommendations made in the updated guidelines for diagnosis and management of infectious diarrhea. […] Stool testing should be performed for Salmonella, Shigella, Campylobacter, Yersinia, C. difficile, and STEC in people with diarrhea accompanied by fever, bloody or mucoid stools, severe abdominal cramping or tenderness, or signs of sepsis (strong, moderate). […] A broader set of bacterial, viral, and parasitic agents should be considered regardless of the presence of fever, bloody or mucoid stools, or other markers of more severe illness in the context of a possible outbreak of diarrheal illness (eg, multiple people with diarrhea who shared a common meal or a sudden rise in observed diarrheal cases).
#16 Approach to the adult with acute diarrhea in resource-abundant settings – UpToDate
https://www.uptodate.com/contents/approach-to-the-adult-with-acute-diarrhea-in-resource-abundant-settings
Most cases of acute diarrhea are due to infections and are self-limited. The major causes of acute infectious diarrhea include viruses (norovirus, rotavirus, adenoviruses, astrovirus, and others), bacteria (Salmonella, Campylobacter, Shigella, enterotoxigenic Escherichia coli, Clostridioides difficile, and others), and protozoa (Cryptosporidium, Giardia, Cyclospora, Entamoeba, and others). […] The main reason for microbiologic stool testing in these patients with acute diarrhea is to identify a potential bacterial pathogen that would inform the potential for complications and treatment decisions. […] For most patients who do not have severe illness or high-risk comorbidities, it is reasonable to continue expectant management for several days without microbiologic stool testing. […] We pursue microbiologic stool testing for patients with acute community-acquired diarrhea and the following features: severe illness, other signs or symptoms concerning for inflammatory diarrhea, high-risk host features, symptoms persisting for more than one week, and public health concerns.
#17 Diagnosis of Diarrhea – NIDDK
https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea/diagnosis
If your doctor thinks its important to find the cause of your diarrhea, they may use your medical and family history, a physical exam, or tests. […] Your doctor may use information from your medical and family history, a physical exam, or tests to find the cause of your diarrhea. […] If your doctor decides diagnostic tests would be helpful, they may use one or more of the following tests to help find the cause of diarrhea. […] Doctors may use stool tests to check for blood, bacteria, parasites, or signs of diseases. […] Blood tests can show signs of certain causes of diarrhea or problems such as dehydration. […] A hydrogen breath test can be used to diagnose lactose intolerance, dietary fructose intolerance, sucrose intolerance, and small intestinal bacterial overgrowth. […] Your doctor may ask you to avoid foods with certain ingredients to see whether your diarrhea responds to a change in diet. […] Your doctor may use endoscopy to view the inside of your digestive tract and help find your cause of diarrhea.
#18 Diarrhea – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/diarrhea/diagnosis-treatment/drc-20352246
Your healthcare professional will likely ask about your medical history, review the medicines you take and conduct a physical exam. Your health professional may order tests to determine what’s causing your diarrhea. Possible tests include: […] A complete blood count, measurement of electrolytes and tests of kidney function can help indicate how bad your diarrhea is. […] You may have a stool test to see if a bacterium or parasite is causing your diarrhea. […] This type of test can help determine if you have a lactose intolerance. […] Using a thin, lighted tube that’s inserted into the rectum, a medical professional can see inside of the colon. […] A medical professional uses a long, thin tube with a camera on the end to examine the stomach and upper small intestine. […] If you’ve tried lifestyle changes and home remedies for diarrhea without success, your healthcare professional might recommend medicines or other treatments.
#19 Chronic Diarrhea in Adults: Evaluation and Differential Diagnosis | AAFP
https://www.aafp.org/pubs/afp/issues/2020/0415/p472.html
Chronic diarrhea is defined as a predominantly loose stool lasting longer than four weeks. A patient history and physical examination with a complete blood count, C-reactive protein, anti-tissue transglutaminase immunoglobulin A (IgA), total IgA, and a basic metabolic panel are useful to evaluate for pathologies such as celiac disease or inflammatory bowel disease. More targeted testing should be based on the differential diagnosis. […] The differential diagnosis for chronic diarrhea is broad; however, a thorough history and physical examination can narrow the diagnostic evaluation. […] The initial laboratory workup should include a complete blood count, C-reactive protein (CRP) level, anti-tissue transglutaminase immunoglobulin A (IgA) level, total IgA level, and a basic metabolic panel.
#20 Diarrhea – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/diarrhea/diagnosis-treatment/drc-20352246
Your healthcare professional will likely ask about your medical history, review the medicines you take and conduct a physical exam. Your health professional may order tests to determine what’s causing your diarrhea. Possible tests include: […] A complete blood count, measurement of electrolytes and tests of kidney function can help indicate how bad your diarrhea is. […] You may have a stool test to see if a bacterium or parasite is causing your diarrhea. […] This type of test can help determine if you have a lactose intolerance. […] Using a thin, lighted tube that’s inserted into the rectum, a medical professional can see inside of the colon. […] A medical professional uses a long, thin tube with a camera on the end to examine the stomach and upper small intestine. […] If you’ve tried lifestyle changes and home remedies for diarrhea without success, your healthcare professional might recommend medicines or other treatments.
#21 Diarrhea Workup: Laboratory Studies, Other Tests, Procedures
https://emedicine.medscape.com/article/928598-workup
In patients with diarrhea, a stool pH level of 5.5 or less or presence of reducing substances indicates carbohydrate intolerance, which is usually secondary to viral illness and transient in nature. […] Enteroinvasive infections of the large bowel cause leukocytes, predominantly neutrophils, to be shed into stool. Absence of fecal leukocytes does not eliminate the possibility of enteroinvasive organisms. However, presence of fecal leukocytes eliminates consideration of enterotoxigenic E coli, Vibrio species, and viruses. […] Examine any exudates found in stool for leukocytes. Such exudates highly suggest colitis (80% positive predictive value). Colitis can be infectious, allergic, or part of inflammatory bowel disease (Crohn disease, ulcerative colitis). […] Always culture stool for Salmonella, Shigella, and Campylobacter organisms and Y enterocolitica in the presence of clinical signs of colitis or if fecal leucocytes are found.
#22 Diarrhea: Causes & Diagnosis | BioFire Diagnostics
https://www.biofiredx.com/blog/whats-the-deal-with-diarrhea/
Simply put, diarrhea refers to loose, watery stools. […] Diarrhea is caused by reduced absorption of water by the intestines, or by increased secretion of bodily fluids into the intestine. […] Diarrhea can generally be classified as infectiouscaused by a microorganism such as bacteria, a virus, or a parasiteor non-infectious. […] For the treatment of infectious diarrhea to be most effective, it needs to be specific to the pathogen responsible for it. […] A gastrointestinal diagnostic test is required to pin down the culprit. […] This is why we engineered the BioFire FilmArray Gastrointestinal (GI) Panel. One patient stool sample, one test, and about one hour are all it takes to get results on 22 microorganisms that cause infectious diarrheaincluding 13 bacteria, 5 viruses, and 4 parasites.
#23 Infectious Diarrhea – Guideline for Investigation – Province of British Columbia
https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/infectious-diarrhea-guideline-for-investigation
This document provides guidance for primary care practitioners regarding adults and children greater than 2 months of age on appropriate testing for suspected community onset infectious diarrhea, including Clostridioides difficile (formerly Clostridium difficile) infection (CDI). […] The Infectious Diarrhea Panel (IDP) is a new stool test that combines stool cultures, ova parasites (OP) and C. difficile. IDP detects a standardized set of 14 viral, bacterial and protozoa pathogens within a single specimen. […] The Infectious Diarrhea Panel (IDP) should be requested if diarrhea is severe of any duration or prolonged 7 days. This is a new test that replaces stool cultures and OP, and it also detects C. difficile. […] For most patients with infectious diarrhea, treatment is supportive with targeted antimicrobial management guided by the patients clinical history, course of illness and pathogen identified by IDP.
#24 New concepts in diagnostics for infectious diarrhea | Mucosal Immunology
https://www.nature.com/articles/mi201350
Diagnostically, a patchwork of modalities is available, including culture, microscopy, and antigen-based tests. […] Antigen-based testing represents a substantial advance for diarrheal diagnostics, in particular for viral and protozoal pathogens. […] Molecular diagnostics have an emerging role in the diagnosis of infectious diseases. […] These tests generally involve the amplification of DNA or RNA. […] There is a great promise for molecular diagnostics for diarrhea in particular, where enhanced sensitivity is desirable and diagnostic yield is typically poor. […] The first critical step for any molecular-based test is the extraction of nucleic acid from the sample. […] PCR is, by far, the most common technique for nucleic acid amplification. […] The sensitivity of PCR has started to change our understanding of diarrheal disease.
#25 Diagnosis of Diarrhea – NIDDK
https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea/diagnosis
If your doctor thinks its important to find the cause of your diarrhea, they may use your medical and family history, a physical exam, or tests. […] Your doctor may use information from your medical and family history, a physical exam, or tests to find the cause of your diarrhea. […] If your doctor decides diagnostic tests would be helpful, they may use one or more of the following tests to help find the cause of diarrhea. […] Doctors may use stool tests to check for blood, bacteria, parasites, or signs of diseases. […] Blood tests can show signs of certain causes of diarrhea or problems such as dehydration. […] A hydrogen breath test can be used to diagnose lactose intolerance, dietary fructose intolerance, sucrose intolerance, and small intestinal bacterial overgrowth. […] Your doctor may ask you to avoid foods with certain ingredients to see whether your diarrhea responds to a change in diet. […] Your doctor may use endoscopy to view the inside of your digestive tract and help find your cause of diarrhea.
#26 Common Causes of Diarrhea
https://www.webmd.com/digestive-disorders/digestive-diseases-diarrhea
Imaging tests that can show if there’s anything wrong with how your organs are shaped or formed […] Fasting tests, which can reveal if you have trouble digesting specific foods (food intolerance) or if certain foods trigger an immune response (food allergy) […] A hydrogen breath test, which can find out if you’re intolerant to lactose or fructose and if you have too much bacteria in your gut.
#27 Acute Diarrhea in Adults | AAFP
https://www.aafp.org/pubs/afp/issues/2014/0201/p180.html
Testing for Clostridium difficile toxins A and B should be performed in patients who develop unexplained diarrhea after three days of hospitalization. […] Routine testing for ova and parasites in acute diarrhea is not necessary in developed countries, unless the patient is in a high-risk group. […] The first step to treating acute diarrhea is rehydration, preferably oral rehydration. […] Antibiotics (usually a quinolone) reduce the duration and severity of traveler’s diarrhea. […] Testing stool for leukocytes to screen for inflammatory diarrhea poses several challenges, including the handling of specimens and the standardization of laboratory processing and interpretation. […] The role of endoscopy in the diagnosis and management of acute diarrhea is limited. Endoscopic evaluation may be considered if the diagnosis is unclear after routine blood and stool tests, if empiric therapy is ineffective, or if symptoms persist.
#28 Chronic Diarrhea Diagnosis | Stanford Health Care
https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-diarrhea/diagnosis.html
Our goal is to quickly determine whether your diarrhea is due to an underlying condition, such as infection or food intolerance, or something more advanced, such as irritable bowel syndrome. […] We offer a broad range of diagnostic tests both within and outside of our Gastrointestinal Motility Lab, including: […] Abdominal computed tomography (CT) scan: Using X-rays and special computer software, this test creates two- and three-dimensional images of your intestines. […] Blood tests: Using a sample of your blood, we may run a number of tests: […] Colonoscopy or sigmoidoscopy: Examining the entire length of your colon (colonoscopy) or just the lower part of your colon (sigmoidoscopy) with the help of a small flexible tube and tiny camera we insert into your rectum. […] Double balloon enteroscopy: Accessing your upper or lower small intestine with a small flexible tube and tiny camera that we pass through your mouth and esophagus, or rectum (enteroscope).
#29 Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition | Gut
https://gut.bmj.com/content/67/8/1380
We recommend blood and stool tests to exclude malabsorption and common infections (especially in the immunocompromised or elderly) (Grade of evidence level 2, Strength of recommendation strong). […] We recommend colonoscopy with biopsies of right and left colon (not rectal) to exclude microscopic colitis (Grade of evidence level 1, Strength of recommendation strong). […] We recommend faecal elastase testing when fat malabsorption is suspected. We do not recommend PABA testing (Grade of evidence level 1, Strength of recommendation strong). […] We recommend an initial screening blood test (full blood count, ferritin, tissue transglutaminase/EMA and thyroid function test) as well as stool tests for inflammation (faecal calprotectin) should be undertaken in primary care (Grade of evidence level 3, Strength of recommendation strong).
#30 Differential Diagnosis for Chronic Diarrhea: Are Multiple Random Biopsies with Colonoscopy Mandatory?
https://www.e-ce.org/journal/view.php?doi=10.5946/ce.2021.030
Differential Diagnosis for Chronic Diarrhea: Are Multiple Random Biopsies with Colonoscopy Mandatory? […] Colonoscopy was performed to identify the cause of chronic diarrhea. […] Multiple random biopsies are essential for differential diagnosis, considering that the majority of the presenting symptoms are non-specific and it is difficult to distinguish them from those of irritable bowel syndrome. […] Therefore multiple random biopsies should be performed to evaluate the cause of chronic diarrhea.
#31 Chronic Diarrhea Diagnosis | Stanford Health Care
https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-diarrhea/diagnosis.html
Our goal is to quickly determine whether your diarrhea is due to an underlying condition, such as infection or food intolerance, or something more advanced, such as irritable bowel syndrome. […] We offer a broad range of diagnostic tests both within and outside of our Gastrointestinal Motility Lab, including: […] Abdominal computed tomography (CT) scan: Using X-rays and special computer software, this test creates two- and three-dimensional images of your intestines. […] Blood tests: Using a sample of your blood, we may run a number of tests: […] Colonoscopy or sigmoidoscopy: Examining the entire length of your colon (colonoscopy) or just the lower part of your colon (sigmoidoscopy) with the help of a small flexible tube and tiny camera we insert into your rectum. […] Double balloon enteroscopy: Accessing your upper or lower small intestine with a small flexible tube and tiny camera that we pass through your mouth and esophagus, or rectum (enteroscope).
#32 Common Causes of Diarrhea
https://www.webmd.com/digestive-disorders/digestive-diseases-diarrhea
Imaging tests that can show if there’s anything wrong with how your organs are shaped or formed […] Fasting tests, which can reveal if you have trouble digesting specific foods (food intolerance) or if certain foods trigger an immune response (food allergy) […] A hydrogen breath test, which can find out if you’re intolerant to lactose or fructose and if you have too much bacteria in your gut.
#33 Chronic Diarrhea Diagnosis | Stanford Health Care
https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/chronic-diarrhea/diagnosis.html
Stool culture: Examining a sample of your stool to test for bacteria, parasites, or viruses in your intestines. […] Wireless capsule gastrointestinal monitoring system: Swallowing a pill with a tiny wireless monitoring system inside (SmartPill) to record acid levels, temperature, and pressure changes in your GI tract. […] Upper endoscopy: With the help of a small flexible tube and tiny camera that we pass through your mouth and esophagus (endoscope), we carefully examine the lining of your stomach and duodenum for ulcers, inflammation, infection, and cancer. […] Defecating proctogram: Examining all structures in your pelvic floor, rectum, and sphincter, with the help of X-ray.
#34 Watery Diarrhea Causes and Relief
https://www.verywellhealth.com/watery-diarrhea-overview-4582424
Endoscopy: For an upper endoscopy, the flexible scope is threaded into the mouth to view the stomach and small intestine. For a colonoscopy, a flexible scope is threaded through the anus to view the rectum and large intestine. […] If you have IBS, an elimination diet test may be used to identify foods (like dairy or wheat) that cause you diarrhea. The foods are then reintroduced one by one to see if any cause diarrhea.
#35 Diarrhea: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/4108-diarrhea
Diarrhea means having a loose, watery stool during a bowel movement. If it doesn’t improve or if you’re experiencing other symptoms like a fever or bloody stool, reach out to a provider to get the treatment (and relief) you need. […] Diarrhea is usually mild (only a few bathroom trips a day) and goes away within a few days. […] Sometimes, though, diarrhea is a sign of a serious condition. […] Diarrhea goes by different names depending on how long it lasts: Acute diarrhea is loose, watery diarrhea that lasts one to two days. […] Chronic diarrhea lasts more than four weeks or comes and goes regularly over a long period. […] The main cause of diarrhea is a virus that infects your gut (gastroenteritis). […] Pathogens (viruses, bacteria and parasites) can all cause infections that lead to diarrhea.
#36 Diarrhea – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK448082/
Diarrhea is a common condition that varies in severity and etiology. Its evaluation varies depending on duration, severity, and the presence of certain concurrent symptoms. Treatment also varies, though rehydration therapy is an important aspect of managing any patient with diarrhea. This activity reviews the evaluation and treatment of diarrhea and stresses the role of the interprofessional team in caring for patients with this condition. […] Diarrhea is categorized into acute or chronic and infectious or non-infectious based on the duration and type of symptoms. Acute diarrhea is defined as an episode lasting less than 2 weeks. Infection most commonly causes acute diarrhea. Most cases result from a viral infection, and the course is self-limited. Chronic diarrhea is defined as a duration lasting longer than 2 weeks and tends to be non-infectious. Common causes include malabsorption, inflammatory bowel disease, and medication side effects.
#37 IDSA 2017 Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea
https://www.idsociety.org/practice-guideline/infectious-diarrhea/
These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. […] Summarized below are recommendations made in the updated guidelines for diagnosis and management of infectious diarrhea. […] Stool testing should be performed for Salmonella, Shigella, Campylobacter, Yersinia, C. difficile, and STEC in people with diarrhea accompanied by fever, bloody or mucoid stools, severe abdominal cramping or tenderness, or signs of sepsis (strong, moderate). […] A broader set of bacterial, viral, and parasitic agents should be considered regardless of the presence of fever, bloody or mucoid stools, or other markers of more severe illness in the context of a possible outbreak of diarrheal illness (eg, multiple people with diarrhea who shared a common meal or a sudden rise in observed diarrheal cases).
#38
https://journals.lww.com/jcge/fulltext/2023/08000/differential_diagnosis_of_chronic_diarrhea__an.4.aspx
This narrative provides an overview of strategies to differentiate and accurately diagnose the myriad of diarrhea-related illnesses seen in clinical practice with a focus on IBS with diarrhea (IBS-D) and EPI. […] Patients with IBS-D pass Bristol Stool Form Scale type 6 or type 7 stools (loose, mushy, watery) during more than 25% of bowel movements and types 1 and 2 stools (hard, lumpy, pellet-like) less than 25% of the time. […] Because the symptoms of IBS-D may overlap with those of other conditions, such as EPI, celiac disease, small intestinal bacterial overgrowth, disaccharidase deficiencies, Crohns disease, ulcerative colitis, and infections, diagnosis is not always straightforward. […] EPI should be considered in patients with chronic diarrhea in the presence of any of the following: history of pancreatic disease, risk factors of pancreatic disease, family history of pancreatic diseases, or pancreatic or gastric surgery.
#39 Chronic Diarrhea in Adults: Evaluation and Differential Diagnosis | AAFP
https://www.aafp.org/pubs/afp/issues/2020/0415/p472.html
A patient who meets Rome IV diagnostic criteria for IBS, has routine physical examination and initial laboratory results, and has no alarm features may be diagnosed with IBS. […] When the initial evaluation fails to narrow the differential diagnosis, testing for fecal occult blood (i.e., fecal immunochemistry test), fecal calprotectin (i.e., leukocytes or lactoferrin), and fecal fat (i.e., Sudan stain) may be helpful to categorize diarrhea as watery, fatty, or inflammatory. […] Inflammatory diarrhea is characterized by the presence of fecal leukocytes, lactoferrin or calprotectin, or blood. Further investigation of inflammatory diarrhea, including advanced imaging and colonoscopy, is always warranted.
#40
https://journals.lww.com/jcge/fulltext/2023/08000/differential_diagnosis_of_chronic_diarrhea__an.4.aspx
Chronic diarrhea, defined as diarrhea persisting for more than 4 weeks, affects up to 5% of the population regardless of patient age, sex, race, or socioeconomic status. […] The differential diagnosis of chronic diarrhea is broad, with etiologies including infections, endocrinopathies, maldigestive/malabsorptive conditions, and disorders of gut-brain interaction. […] The considerable overlap of symptoms across this spectrum makes accurate diagnosis problematic and may lead to delays in diagnosis or misdiagnosis. […] We outline a 4-step diagnostic strategy and propose a straightforward algorithm to assist in efficiently differentiating irritable bowel syndrome from exocrine pancreatic insufficiency and other causes of chronic diarrhea. […] Efficient and accurate diagnoses are essential.
#41 Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition | Gut
https://gut.bmj.com/content/67/8/1380
Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). […] These guidelines deal with clinical assessment in primary and secondary care of a patient with diarrhoea, the exclusion of cancer or inflammation, and detecting common disorders such as bile acid diarrhoea, microscopic colitis, lactose malabsorption or post radiation diarrhoea, together with rarer causes of malabsorption and surgical disorders as outlined in figure 1. Options for therapy are not dealt with as it is beyond the remit of this guideline, nor has the cost effectiveness of investigations been addressed due to paucity of available evidence.
#42 Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition | Gut
https://gut.bmj.com/content/67/8/1380
We recommend a careful detailed history to plan investigations (Grade of evidence level 1, Strength of recommendation strong). […] We recommend screening blood tests for the exclusion of anaemia, coeliac disease, etc as well as stool tests for inflammation (Grade of evidence level 1, Strength of recommendation strong). […] We recommend making a positive diagnosis of irritable bowel syndrome (IBS) following basic blood and stool screening tests (Grade of evidence level 2, Strength of recommendation strong). […] We recommend excluding colorectal cancer in those with altered bowel habitrectalbleeding by colonoscopy (Grade of evidence level 1, Strength of recommendation strong). […] Faecal calprotectin is recommended to exclude colonic inflammation in those suspected with IBS and under the age of 40 (Grade of evidence level 1, Strength of recommendation strong).
#43 Evaluation of chronic diarrhea – Differential diagnosis of symptoms | BMJ Best Practice US
https://bestpractice.bmj.com/topics/en-us/144
Chronic diarrhea is defined as the presence of 3 loose stools per day for more than 4 weeks. […] Diagnosis can be challenging as a large number of etiologies present in a similar way and range from benign to life threatening. A systematic method of evaluation, knowledge of the common causes, and an understanding of the local epidemiology are crucial for efficient and effective diagnosis and management of chronic diarrhea. […] Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition.
#44 AGA releases guideline on the evaluation of chronic diarrhea – American Gastroenterological AssociationAGA Logo_Horizontal
https://gastro.org/press-releases/aga-releases-guideline-on-the-evaluation-of-chronic-diarrhea-1/
When managing patients with chronic watery diarrhea, it is important for health care providers to determine whether it is being caused by organic disease or a functional disorder, such as functional diarrhea or irritable bowel syndrome with diarrhea. […] The AGA guideline on evaluation of chronic diarrhea is intended to reduce practice variation and promote high-quality and high-value care for this patient population. […] The guideline recommends considering the use of the following laboratory tests for the evaluation of functional diarrhea and IBS-D in adults: In patients presenting with chronic diarrhea, AGA suggests the use of either fecal calprotectin or fecal lactoferrin, which have been proposed as markers for inflammatory conditions, such as IBD. […] In patients presenting with chronic diarrhea, AGA recommends testing for Giardia, a common cause of watery diarrhea that can be readily treated.
#45 AGA releases guideline on the evaluation of chronic diarrhea – American Gastroenterological AssociationAGA Logo_Horizontal
https://gastro.org/press-releases/aga-releases-guideline-on-the-evaluation-of-chronic-diarrhea-1/
In patients presenting with chronic diarrhea, AGA recommends testing for celiac disease with IgA tissue transglutaminase and a second test to detect celiac disease in the setting of IgA deficiency. Celiac disease is an important cause of chronic diarrhea. […] Read the AGA Clinical Practice Guidelines on the Laboratory Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome in Adults (IBS-D) to review the complete recommendations. […] Diarrhea happens when a patient has loose, watery stools three or more times a day. When diarrhea lasts four weeks or more, it is considered chronic, or long-term, diarrhea. […] There are different types of IBS â IBS-D: IBS with diarrhea; IBS-C: IBS with constipation; IBS-M: IBS mixed. General symptoms for all types can include belly pain, cramping in the stomach area, gas, bloating and changes in the stool, such as diarrhea, constipation or an urgent need to go.
#46
https://journals.lww.com/jcge/fulltext/2023/08000/differential_diagnosis_of_chronic_diarrhea__an.4.aspx
Definitive diagnosis of EPI, often challenging due to the lack of accurate tests, is extremely important to avoid complications. […] Diagnosis typically requires a combination of symptoms, nutritional markers, and a noninvasive pancreatic function test, such as coefficient of fat absorption (CFA) and fecal elastase (FE-1). […] EPI is one of several organic gastrointestinal diseases that may mimic IBS. […] Early and accurate diagnosis is essential in disease management. […] To assist in the accurate diagnosis of patients presenting with chronic diarrhea, we suggest a four-step diagnostic process. […] The history and physical examination should guide the diagnostic strategy. […] If alarm signs or symptoms are present, testing should be based on the most likely etiologic causes. […] The algorithm provides a simple framework for making a rapid and accurate diagnosis of IBS-D. […] This simple algorithm should assist practitioners in making timely diagnoses and reduce superfluous testing, thus reducing delays in treatment and improving patient health and quality of life.
#47 Post-Travel Diarrhea | Yellow Book | CDC
https://wwwnc.cdc.gov/travel/yellowbook/2024/posttravel-evaluation/persistent-diarrhea-in-returned-travelers
Healthcare professionals should know how to evaluate international travelers with diarrheal illness after travel. […] Most cases of travelers’ diarrhea (TD) are acute and self-limited, some people develop persistent (14 days) gastrointestinal (GI) symptoms. […] The initial workup of persistent TD should always include C. difficile testing. […] Diagnosis can be made by stool polymerase chain reaction (PCR), microscopy, enzyme immunoassay, or immunofluorescence. […] Diagnostic tests to determine specific microbial etiologies in cases of post-travel diarrhea have advanced in the past number of years. […] For persistent diarrhea, specific treatment of identified enteropathogens is usually indicated and appropriate management of underlying GI disease is warranted.
#48 IDSA 2017 Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea
https://www.idsociety.org/practice-guideline/infectious-diarrhea/
Diagnostic testing is not recommended in most cases of uncomplicated travelers diarrhea unless treatment is indicated. […] Testing for C. difficile should be performed in travelers treated with antimicrobial agent(s) within the preceding 8-12 weeks. […] Antimicrobial treatment should be modified or discontinued when a clinically plausible organism is identified (strong, high). […] Follow-up testing is not recommended in most people for case management following resolution of diarrhea (strong, moderate). […] Antimicrobial therapy for people with infections attributed to STEC O157 and other STEC that produce Shiga toxin 2 (or if the toxin genotype is unknown) should be avoided (strong, moderate). […] Probiotic preparations may be offered to reduce the symptom severity and duration in immunocompetent adults and children with infectious or antimicrobial-associated diarrhea (weak, moderate).
#49 Infectious Diarrhea | Choose the Right Test
https://arupconsult.com/content/infectious-diarrhea
Rapid diagnosis is important for appropriate treatment and infection control measures. […] The gold standard for diagnosis of parasitic diarrhea involves manual staining and microscopic review of stool samples. Ova and parasite examination is a common laboratory test in patients with diarrhea, although parasitic diarrhea is relatively rare and manual ova and parasite examination is a time- and resource-consuming process with variable sensitivity. […] A broader differential diagnosis is recommended for immunocompromised patients compared with immunocompetent patients. This is particularly important for patients with moderate and severe primary or secondary immunodeficiencies. Patients with AIDS who present with persistent diarrhea should undergo additional testing, including testing for Cryptosporidium, Cyclospora, Cystoisospora, microsporidia, Mycobacterium avium complex, and cytomegalovirus.
#50 Infectious Diarrhea | Choose the Right Test
https://arupconsult.com/content/infectious-diarrhea
Laboratory testing for Clostridioides difficile (formerly known as Clostridium difficile) is described fully in the ARUP Consult Clostridioides difficile topic. Briefly, the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) recommend C. difficile infection (CDI) testing for patients with CDI risk factors and unexplained and new-onset diarrhea, with three or more loose (unformed) stools within 24 hours. […] People with fever or bloody diarrhea should be evaluated for enteropathogens for which antimicrobial agents may have clinical benefit, including Salmonella enterica subspecies, Shigella, Yersinia, and Campylobacter. […] Laboratory testing for infectious diarrhea is informed by clinical evaluation. The tables below detail testing options for acute, persistent, and chronic diarrhea based on the suspected infectious agent.
#51 Diagnostic approach to diarrhea in children in resource-abundant settings – UpToDate
https://www.uptodate.com/contents/diagnostic-approach-to-diarrhea-in-children-in-resource-rich-countries
Diagnostic approach to diarrhea in children in resource-abundant settings […] Diarrhea refers to the passage of loose or watery stools. The World Health Organization (WHO) defines a case as the passage of three or more loose or watery stools per day. […] Acute infectious gastroenteritis due to viruses accounts for most bouts of diarrhea in resource-abundant settings, resulting in more than 1.5 million outpatient visits and 200,000 hospitalizations in the United States annually. […] Life-threatening conditions â A number of disorders causing diarrhea may be life-threatening in children and occasional patients with diarrhea from any cause may develop severe dehydration. […] Diarrhea is commonly associated with sepsis caused by Salmonella spp and toxigenic strains of Staphylococcus aureus (staphylococcal toxic shock syndrome [TSS]).
#52 Diarrhea in Children | ACG
https://gi.org/topics/diarrhea-in-children/
The diagnosis of chronic diarrhea usually requires confirmatory tests. Establishing the exact cause of chronic diarrhea may require several different tests, some of which are listed below: […] Your physician can assist you in choosing the best treatment after determining the cause of your childâs diarrhea. […] Diarrhea due to acute infection (acute gastroenteritis) usually does not require tests. In some cases doctors will order blood tests to determine if a child is dehydrated. Collection of stool samples (stool cultures) can be done to identify the specific cause of the diarrhea in some children, especially if they have blood in stools. Stool cultures can take from 2 to 5 days before a result is available. […] The diagnosis of chronic diarrhea usually requires confirmatory tests. Establishing the exact cause of chronic diarrhea may require several different tests, some of which are listed below:
#53 Diarrhea – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/diarrhea/diagnosis-treatment/drc-20352246
Antibiotics or antiparasitic medicines might help treat diarrhea caused by certain bacteria or parasites. […] Your healthcare professional likely will advise you to replace the fluids and salts that you lose when you have diarrhea. […] If drinking liquids upsets your stomach or causes vomiting, your healthcare professional might give you IV fluids. […] If your healthcare professional determines that an antibiotic caused your diarrhea, you might be given a lower dose or a different medicine. […] If your diarrhea is caused by a more serious condition, such as inflammatory bowel disease, your healthcare professional works to control that condition.
#54 Diarrhea – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK448082/
A patient with acute diarrhea typically has a self-limited course and is not require labs or imaging. A stool culture is warranted in a patient with bloody diarrhea or severe illness to rule out bacterial causes. Bloody stools require additional testing for Shiga toxin and lactoferrin. A recent antibiotic or hospitalization patient requires testing for Clostridium difficile infection. […] An important aspect of diarrhea management is replenishing fluid and electrolyte loss. Patients should be encouraged to drink diluted fruit juice, Pedialyte, or Gatorade. In more severe cases of diarrhea, IV fluid rehydration may become necessary. […] The treatment of chronic diarrhea is specific to its etiology. The first step is categorizing diarrhea as watery, fatty, or inflammatory. Once categorized, an algorithm can be used to determine the next step in management. Most cases require additional fecal studies, lab work, or imaging. More invasive procedures like colonoscopy or upper endoscopy may be required.
#55 Diarrheal Diseases â Acute & Chronic | ACG
https://gi.org/topics/diarrhea-acute-and-chronic/
Screening/Diagnosis: Most episodes of acute diarrhea resolve quickly without antibiotic therapy and with simple dietary modifications. See a doctor if you feel ill, have bloody diarrhea, severe abdominal pain or diarrhea lasting more than 48 hours. […] If you have chronic diarrhea, your doctor will want to further assess etiologic factors or complications of diarrhea by obtaining several tests. […] A stool sample may help define the type of diarrhea. […] Endoscopic examination of the colon with flexible sigmoidoscopy or colonoscopy and upper endoscopy are helpful in detecting the etiology of chronic diarrhea, as this allows direct examination of the bowel mucosa and the ability to obtain biopsies for microscopic evaluation. […] Treating Acute Diarrhea: It is important to take plenty of fluid with sugar and salt to avoid dehydration.
#56 Diarrhea Nursing Diagnosis & Care Plan – Nurseslabs
https://nurseslabs.com/diarrhea/
Aside from antidiarrheal agents, nutritional support, and antimicrobial therapy, one of the primary treatments for diarrhea is fluid replacement. Severely dehydrated patients should be immediately managed and treated with intravenous Ringers lactate or saline solution, with additional potassium and bicarbonate as needed. Oral rehydration solutions are used extensively to replace diarrheal fluid and electrolyte losses.
#57 Diarrhea: Diagnosis & Treatment | NewYork-Presbyterian
https://www.nyp.org/primary-care/diarrhea/treatment
How is Diarrhea Diagnosed? Diagnosis Most cases of diarrhea do not require medical attention; however, if the diarrhea is severe, call your healthcare provider for an appointment. Your doctor may run the following tests to find the right diagnosis and treatment for you: […] Stool sample – A stool sample will be examined to determine if the reason for the diarrhea is bacterial or parasitic. Stool testing is the most common way to examine a stool culture for gastrointestinal pathogens such as clostridium difficile (C. diff), fecal trypsin/chymotrypsin, along with a wide range of other possible pathogens. […] If you are concerned that diarrhea has lasted longer than four days, make an appointment with your primary care physician. […] Most cases of diarrhea do not require a visit to the doctor.
#58 Diarrhea: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/4108-diarrhea
Usually, you can get rid of diarrhea at home. […] You can often get rid of acute diarrhea through lifestyle changes you can make at home. […] Call your child’s pediatrician if they have severe diarrhea. […] You can’t always prevent diarrhea, but you can reduce your risk of getting it because of infections or food contamination. […] Call your healthcare provider if you have diarrhea that doesn’t improve or go away within a few days.
#59 Diarrhea – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/diarrhea/symptoms-causes/syc-20352241
Diarrhea loose, watery and possibly more-frequent passage of stool is a common problem. […] But when diarrhea lasts beyond a few days, it is usually a clue to another problem such as medicine side effects, changes in diet, irritable bowel syndrome (IBS), or a more serious disorder, including ongoing infection, celiac disease or inflammatory bowel disease (IBD). […] If you’re an adult, see your doctor if: Your diarrhea doesn’t get better or stop after two days. […] A number of diseases and conditions can cause diarrhea, including: […] Some medicines, such as antibiotics, laxatives, magnesium supplements, antidepressants, NSAIDs, chemotherapy and immunotherapy, can cause diarrhea. […] Diarrhea can cause dehydration, which can be life-threatening if not treated. […] If you have symptoms of serious dehydration, seek medical help.
#60 What Tests Are Done for Diarrhea? – MyHealth
https://redcliffelabs.com/myhealth/blood-test/what-tests-are-done-for-diarrhea/
Diarrhea is typically a major concern in infants, children, and older people since it can indicate an underlying infection or disease that needs immediate attention. […] If the symptoms dont get better within a day or two, consulting a doctor and getting relevant testing is crucial for the proper administration of the required treatment. […] Medical assistance is necessary if the symptoms last for over 48 hours. […] The diagnosis or testing procedure involves: Self-monitoring, Lab-based testing after doctors consultation, Imaging tests for ruling out additional suspicions. […] If the diarrhea symptoms are persistent even after 48 hours (24 hours for children), consulting a doctor is your best bet. […] Getting a complete picture of the situation and the symptoms allows them to prescribe the required tests that can confirm a diagnosis.
#61 Diarrhoea | Better Health Channel
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diarrhoea
Diarrhoea is the frequent passing of loose, watery faeces. […] Acute diarrhoea is the sudden onset of 3 or more loose stools per day, lasting less than 14 days. […] Successful treatment depends on diagnosing the cause. Investigations may include: medical history, physical examination, blood tests, laboratory analysis of stool sample, colonoscopy the insertion of a slender instrument into the anus so that the doctor can look at the bowel lining. […] Treatment for diarrhoea depends on the cause, but may include: plenty of fluids to prevent dehydration, oral rehydration drinks to replace lost salts and minerals. […] Most cases of acute diarrhoea are potentially infectious to others. […] Anyone with acute diarrhoea should stay at home if possible to reduce the spread of infection.