Chronic diarrhea classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Overview

Chronic diarrhea may be classified into 3 basic categories: watery, fatty (malabsorption), and inflammatory (with blood and pus). It is important to note that not all chronic diarrhea falls into one category alone. Classifying a patient’s chronic diarrhea into a subcategory helps to direct the diagnostic workup.

Chronic diarrhea may be classified into:^[1]^[2]^[3]^[4]

Diarrhea may be classified as inflammatory, when stool analysis tools, such as stool cultures and interventions, such as flexible sigmoidoscopy or colonoscopy with biopsies show evidence of the presence of fecal leukocytes. Causes of inflammatory diarrhea include:

Watery diarrhea can be classified as:

Structural and endocrine diseases should also be considered. These diseases include the following:
- Diabetes
- Hyperthyroidism
- Addison’s disease
- Peptide secreting endocrine tumors

A normal gap is between 50 and 100 mosm/kg.^[6]

Fatty diarrhea can be either due to malabsorption or maldigestion problems:

↑ Fine, K; Schiller, L (1999). “AGA Technical Review on the Evaluation and Management of Chronic Diarrhea☆”. Gastroenterology. 116 (6): 1464–1486. doi:10.1016/S0016-5085(99)70513-5. ISSN 0016-5085.
↑ “American Gastroenterological Association medical position statement: Guidelines for the evaluation and management of chronic diarrhea☆, ☆☆”. Gastroenterology. 116 (6): 1461–1463. 1999. doi:10.1016/S0016-5085(99)70512-3. ISSN 0016-5085.
↑ Camilleri M (2004). “Chronic diarrhea: a review on pathophysiology and management for the clinical gastroenterologist”. Clin Gastroenterol Hepatol. 2 (3): 198–206. PMID 15017602.
↑ Fine KD, Seidel RH, Do K (2000). “The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea”. Gastrointest Endosc. 51 (3): 318–26. PMID 10699778.
↑ Oster JR, Materson BJ, Rogers AI (1980). “Laxative abuse syndrome”. Am J Gastroenterol. 74 (5): 451–8. PMID 7234824.
↑ Shiau, Yih-Fu (1985). “Stool Electrolyte and Osmolality Measurements in the Evaluation of Diarrheal Disorders”. Annals of Internal Medicine. 102 (6): 773. doi:10.7326/0003-4819-102-6-773. ISSN 0003-4819.