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Chronic Diarrhoea
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''Causes in west (in order of frequency)'' IBS/functional Lactose intolerance (or other diet) Coeliac Small bowel infection - giardia, bacterial overgrowth, tropical sprue IBD - Crohns / UC Pancreatic insufficiency/cancer, cystic fibrosis Radiation enteritis Neoplasia / drugs / metabolic / autonomic neuropathy .... 5% adults (M>F) - report loose stool functional (no pain) or IBS (with pain, 4 per 100 in UK, F more likely to see GP) Lactose intolerance - adult acquired hypolactasia - mutation occured in NW europe - 10% adults intolerant, 40% SE europe and 90% orientals Coeliac - 1 in 100 - 1/2 diagnosed as adults Giardia - tropics, campers, backpackers IBD - UC 12 and Corhns 24 per 10000 bacterial overgrowth often in elderly with achlorhydria (iatrogenic) IBS diet, drugs, psych ''Present with ...'' abdo pain esp IBS - also Crohns and pancreatic disease weight loss - Crohns and pancreatic disease and neoplasia vomiting - chronic diarrhoea may occur post acute gastro steatorrhoea and abdo distention coeliac, pancreatic insufficiency, and giardia Blood in stool - UC, Crohns, cancer outlet bleeding (bright red on paper) - exclude IBD and colon ca Urgency is common in chronic diarrhoea Nocturnal diarrhoea is rarely IBS or functional ''Red flags'' age > 50 short history weight loss nocturnal Sx Male FH colon ca anaemia rectal bleeding recent antibiotic use Drugs - PPI, SSRI, ACE, BB, statins, metformin, mefenamic acid
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Diarrhoea