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Classification of chronic diarrhoea

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Classification of chronic diarrhoea (1, 2)

Chronic diarrhoea can be divided into six broad categories.

  • osmotic
    • medications e.g. - laxatives
    • undigested sugars e.g. diet foods/drinks/gum

  • secretory
    • medications e.g. - non-osmotic laxatives, antibiotics etc
    • small intestinal bacterial overgrowth
    • endocrine e.g. - carcinoid, gastrinoma, adrenal insufficiency, hyperthyroidism
    • bile salt malabsorption e.g. - ileal resection, idiopathic, post cholecystectomy
    • non-invasive infections e.g. - giardiasis, cryptosporidiosis

  • steatorrhoea
    • maldigestion
      • decreased bile salts - cirrhosis, bile duct obstruction, ileal resection
      • pancreatic dysfunction - chronic pancreatitis, cystic fibrosis
    • malabsorption e.g. - Coeliac sprue, tropical sprue, Chronic mesenteric ischaemia, short bowel syndrome

  • inflammatory
    • inflammatory bowel disease e.g. - ulcerative colitis, Crohn's disease,
    • malignancy e.g. - colon cancer, lymphoma
    • radiation colitis

  • motility
    • post-surgical (vagotomy, dumping)
    • scleroderma
    • diabetes
    • hyperthyroidism

  • miscellaneous
    • irritable bowel syndrome
    • fictitious

References:

  1. Schiller LR et al. Gastro 2013 APDW/WCOG Shanghai working party report: chronic diarrhea: definition, classification, diagnosis. J Gastroenterol Hepatol. 2014;29(1):6-25.
  2. Sweetser S. Evaluating the patient with diarrhoea: a case-based approach. Mayo Clin Proc. 2012 Jun;87(6):596-602

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