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The patient with refractory diarrhoea

journal contribution
posted on 2023-06-08, 10:13 authored by Michael Farthing
Persistent diarrhoea continues to present a management challenge to clinicians around the world. The investigation of persistent diarrhoea requires a logical hierarchical approach to ensure that resources are used appropriately and patients are not put at unnecessary risks during the investigative process. A 5-step process is described in which functional diarrhoea is excluded early in the workup, which might include a measurement of 24 h faecal weight. Once infection, drugs and laxatives have been excluded more invasive tests such as endoscopy are sequentially introduced to exclude inflammatory disease and small bowel and pancreatic malabsorption. When the common causes have been excluded there remains a group of patients with high volume watery diarrhoea due to a variety of causes include the neuroendocrine diarrhoeas. A case of fictitious diarrhoea is described which illustrates the value of complete fluid balance studies, faecal osmolality and other biochemical faecal analyses. The management of some selected causes of refractory diarrhoea is discussed including functional diarrhoea, diabetic diarrhoea, diarrhoea dues to protozoal infections, microscopic colitis and antibiotic associated diarrhoea.

History

Publication status

  • Published

Journal

Best Practice & Research: Clinical Gastroenterology

ISSN

1521-6918

Publisher

Elsevier

Issue

3

Volume

21

Page range

485-501

Department affiliated with

  • Clinical and Experimental Medicine Publications

Full text available

  • No

Peer reviewed?

  • Yes

Legacy Posted Date

2012-02-07

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