The patient with refractory diarrhoea

Farthing, Michael (2007) The patient with refractory diarrhoea. Best Practice & Research: Clinical Gastroenterology, 21 (3). pp. 485-501. ISSN 1521-6918

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Abstract

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.

Item Type: Article
Keywords: refractory diarrhoea; faecal weight; functional diarrhoea; diabetic diarrhoea; intestinal protozoa
Schools and Departments: Brighton and Sussex Medical School > Clinical Medicine
Depositing User: Michael Farthing
Date Deposited: 07 Feb 2012 15:52
Last Modified: 31 Jul 2012 08:34
URI: http://sro.sussex.ac.uk/id/eprint/36058
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