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Chronic Diarrhea

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Chronic diarrhea is a gastrointestinal condition characterized by the frequent passage of loose and watery stools for a duration of four weeks or longer.<a href="#accordion">[1]</a> 
&nbsp;

According to research in five Southeast Asian countries, the prevalence of diarrhea varies from 8.39% in the Philippines to 18.21% in Indonesia.<a href="#accordion">[2]</a>

The condition can be fatal, especially among children. Globally,1 in 9 child deaths are due to diarrheal illnesses.<a href="#accordion">[3]</a>

The World Health Organization (WHO) has ranked Pakistan 23rd in terms of childhood mortality caused by diarrheal illness, with almost 6.4 million cases of pediatric diarrhea annually.<a href="#accordion">[5]</a> 
&nbsp;

There are several types of chronic diarrhea, each with distinct underlying causes.<a href="#accordion">[1][6]</a> 
&nbsp;

<ul>
	<li>
	<h5>Watery Diarrhea</h5>
	</li>
</ul>

It is further categorized into osmotic and secretory diarrhea. That is, the colon is either unable to reabsorb enough electrolytes and water from the poop or it&rsquo;s secreting more than it&#39;s absorbing.

Causes Include: Hyperthyroidism, bile acid malabsorption, diabetes-related neuropathy, adrenal disorders, irritable bowel syndrome (IBS), microscopic colitis, vagotomy, and neuroendocrine tumors. 
&nbsp;

<ul>
	<li>
	<h5>Steatorrhea</h5>
	</li>
</ul>

At times, having too much fat in the stool can turn it into diarrhea. This can occur when the body struggles to break down and absorb fats or when the bacteria in the stomach produce fatty acids in excess. Fatty diarrhea might not happen often. Also, it leaves an oily residue in the toilet. The individual also experiences nausea, weight loss, and indigestion.

Causes Include: Small intestinal bacterial overgrowth, gastric bypass surgery, chronic pancreatitis,lactose intolerance, celiac disease, Whipple disease, and mesenteric ischemia. 
&nbsp;

<ul>
	<li>
	<h5>Inflammatory Diarrhea</h5>
	</li>
</ul>

Inflammatory diarrhea happens when the colon becomes inflamed or swollen. This inflammation affects the inner lining of the colon. Inflammatory diarrhea bouts are more frequent, though in smaller amounts. It can also trigger stomach pain, fever, or bleeding.

Causes Include: Cancer, inflammatory bowel disease (IBD), radiation colitis, ischemic colitis, persistent infections like C. diff, and diverticulitis. 
&nbsp;

Sign and Symptoms

These include:

<ul>
	<li>Frequent bowel movements (3 or more times in 24 hours)<a href="#accordion">[8]</a></li>
	<li>Abdominal cramping and pain</li>
	<li>Bloating and gas</li>
	<li>Nausea</li>
	<li>Fatigue and weakness</li>
	<li>Weight loss</li>
	<li>Dehydration 
	&nbsp;</li>
</ul>

Causes

The common causes of chronic diarrhea include:

<ul>
	<li>Bacterial, viral, or parasitic infections</li>
	<li>Gastrointestinal conditions like IBD, IBS, and celiac disease</li>
	<li>Certain medications, such as antibiotics, antacids, and cancer drugs</li>
	<li>Food intolerance</li>
	<li>Food allergy</li>
	<li>Complication of surgery on the gallbladder or stomach</li>
	<li>Damage from radiation treatments 
	&nbsp;</li>
</ul>

Diagnosis

<ul>
	<li>Stool Tests: These tests can identify infections, parasites, and markers of inflammation in the stool.</li>
	<li>Blood Tests: Blood tests help diagnose conditions like celiac disease and assess electrolyte levels.</li>
	<li>Colonoscopy: This procedure allows doctors to visualize the colon lining and collect tissue samples for analysis.</li>
	<li>Endoscopy: Upper endoscopy helps examine the upper digestive tract for abnormalities. 
	&nbsp;</li>
</ul>

Treatment

The treatment of chronic diarrhea depends on its underlying cause.

<ul>
	<li>Medications: Antidiarrheal medications, anti-inflammatory drugs, and medications targeting specific conditions are prescribed.</li>
	<li>Dietary Changes: Adjusting the diet to avoid trigger foods, adopting a low-FODMAP diet, or following a gluten-free diet can help manage chronic diarrhea.<a href="#accordion">[7]</a></li>
	<li>Fluid Replacement: Ensuring proper hydration is crucial, especially during episodes of diarrhea.<a href="#accordion">[4]</a> 
	&nbsp;</li>
</ul>

These include:

<ul>
	<li>Dehydration</li>
	<li>Malnutrition</li>
	<li>Electrolyte imbalance that can affect the heart, brain, lungs, and nervous system</li>
	<li>Kidney disease 
	&nbsp;</li>
</ul>

Several risk factors increase the likelihood of developing chronic diarrhea.

<ul>
	<li>Age: The elderly and young children are more susceptible.</li>
	<li>Medical History: A history of gastrointestinal disorders or surgeries increases the risk.</li>
	<li>Travel: Exposure to new pathogens while traveling can trigger chronic diarrhea. 
	&nbsp;</li>
</ul>

The following interventions can help reduce the risk of chronic diarrhea:

<ul>
	<li>Practice Good Hygiene: Wash hands thoroughly and avoid consuming contaminated water and food.</li>
	<li>Dietary Modifications: Make dietary changes to address food intolerances.</li>
	<li>Stress Management: Stress reduction techniques can help manage conditions like IBS. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Chronic diarrhea persists for four weeks or more.</li>
	<li>Types include watery diarrhea, steatorrhea, and inflammatory diarrhea.</li>
	<li>It is characterized by loose stools, abdominal pain, fatigue, and weight loss.</li>
	<li>It is usually caused by infections, gastrointestinal disorders, medications, and food intolerances.</li>
	<li>Screening involves stool and blood tests, while diagnosis employs colonoscopy and endoscopy.</li>
	<li>Treatment includes medications, dietary changes, and fluid replacement.</li>
	<li>Complications comprise dehydration, malnutrition, and electrolyte imbalance.</li>
	<li>Risk factors include age, medical history, and travel exposure.</li>
	<li>Preventive measures involve hygiene, dietary modifications, and stress management.</li>
</ul>

[1] Burgers K, Lindberg B, Bevis ZJ. Chronic Diarrhea in Adults: Evaluation and Differential Diagnosis. Am Fam Physician. 2020 Apr 15;101(8):472-480. PMID: 32293842.

[2] Arifin H, Rakhmawati W, Kurniawati Y, et al. Prevalence and determinants of diarrhea among under-five children in five Southeast Asian countries: Evidence from the demographic health survey. J Pediatr Nurs. 2022;66:e37-e45.

[3] Diarrhea: common illness, global killer. CDC.

[4] UNICEF Pakistan. Accelerating Policy Change, Translation and Implementation for Pneumonia and Diarrhea Commodities.

[5] Rahmat ZS, Zubair A, Abdi I, Humayun N, Arshad F, Essar MY. The rise of diarrheal illnesses in the children of Pakistan amidst COVID-19: A narrative review. Health Sci Rep. 2023;6(1):e1043. Published 2023 Jan 3.

[6] Descoteaux-Friday GJ, Shrimanker I. Chronic Diarrhea. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

[7] Andrews CN, Bradette M. Diarrhea-Predominant Irritable Bowel Syndrome: Medical Management Update. J Can Assoc Gastroenterol. 2019;3(6):e37-e48. Published 2019 Dec 3.