Table 1 lists medications commonly associated with diarrhea 6 however, a patient can experience diarrhea from almost any medication. A complete medication history, including over-the-counter medications, illicit drug use, alcohol use, and supplements, is indicated. A review of systems can reveal extraintestinal manifestations of the disease. 2, 4 A thorough travel and dietary history can help guide the clinician toward an appropriate workup for infections or food intolerance. Inflammatory diarrhea warrants further evaluation and can be caused by disorders such as inflammatory bowel disease, Clostridioides difficile, colitis, and colorectal cancer.Ĭlinicians should ask patients about key historical features, including stool appearance and odor, the presence of urgency or tenesmus, pain, the frequency and duration of symptoms, whether diarrhea persists at night or with fasting, and possible triggers. Fatty diarrhea can be caused by malabsorption or maldigestion and includes disorders such as celiac disease, giardiasis, and pancreatic exocrine insufficiency. Osmotic diarrhea can present with carbohydrate malabsorption syndromes and laxative abuse. Secretory diarrhea can be caused by bile acid malabsorption, microscopic colitis, endocrine disorders, and some postsurgical states. Functional disorders such as irritable bowel syndrome and functional diarrhea are common causes of chronic diarrhea. Watery diarrhea includes secretory, osmotic, and functional types. Some disorders can cause more than one type of diarrhea. When the differential diagnosis is broad, stool studies should be used to categorize diarrhea as watery, fatty, or inflammatory. More targeted testing should be based on the differential diagnosis. 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. Chronic diarrhea is defined as a predominantly loose stool lasting longer than four weeks.
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