Diarrhea: Encyclopedia II - Diarrhea - Chronic diarrhea

Diarrhea - Chronic diarrhea

Diarrhea - Infective diarrhea

It is not uncommon for diarrhea to persist. Diarrhea due to some organisms may persist for years without significant long term illness. More commonly a diarrhea will slowly ameliorate but the patient becomes a carrier (harbors the infection without illness). This is often an indication for treatment, especially in food workers or institution workers.

Parasites (worms and amoeba) should always be treated. Salmonella is the most common persistent bacterial organism in humans.

Diarrhea - Malabsorption

These tend to be more severe medical illnesses. Malabsorption is the inability to absorb food, mostly in the small bowel but also due to the pancreas.

Causes include celiac disease (intolerance to gluten, a wheat product), lactose intolerance (Intolerance to milk sugar, common in non-Europeans), fructose malabsorption, Pernicious anemia (impaired bowel function due to the inability to absorb vitamin B12), loss of pancreatic secretions (may be due to cystic fibrosis or pancreatitis), short bowel syndrome (surgically removed bowel), radiation fibrosis (usually following cancer treatment), and other drugs such as chemotherapy.

Diarrhea - Inflammatory bowel disease

There are of unknown origin but are likely to be abnormal immune responses to infection. There is some overlap but the two types are ulcerative colitis and Crohn's disease:

• Ulcerative colitis is marked by chronic bloody diarrhea and inflammation mostly affects the distal colon near the rectum.
• Crohn's disease typically affects fairly well demarcated segments of bowel in the colon and often affects the end of the small bowel.

Diarrhea - Irritable Bowel Syndrome

Irritable Bowel Syndrome is of unknown origin but often results from an insult to the gut, and as such can overlap with infective diarrhea, celiac, and inflammatory bowel diseases. IBS is a brain-gut dysfunction that causes visceral hypersensitivity and results in chronic diarrhea (or constipation) in association with lower abdominal pain or discomfort. While there is no direct treatment for the underlying pathology of IBS, symptoms, including diarrhea, can be well managed through a combination of dietary changes, soluble fiber supplements, and/or medications. Gut-directed hypnotherapy is also a very promising avenue of treatment.

Diarrhea - Other important causes

• Ischaemic bowel disease. This usually affects older people and can be due to blocked arteries.
• Bowel cancer: Some (but NOT all) bowel cancers may have associated diarrhea. (Cancer of the large colon is most common.)
• Hormone-secreting tumors: some hormones (e.g. serotonin) can cause diarrhea if excreted to excess (usually from a tumor).
• Bile salt diarrhea: excess bile salt entering the colon rather then being absorbed at the end of the small intestine can cause diarrhea, typically shortly after eating. Bile salt diarrhea is a possible side-effect of gallbladder removal. It is usually treated with cholestyramine, a bile acid sequestrant.

Adapted from the Wikipedia article "Chronic diarrhea", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki