GastroEast Physicians, Louisville, KY

Diarrhea

There are many causes of diarrhea, and it is necessary to identify the cause to provide treatment. Treatment is necessary to alleviate symptoms and provide the patient with a normal quality of life. diarrhea picture 2

Chronic diarrhea
Chronic diarrhea can have effect on quality of life and overall health. Usually chronic diarrhea is a mild inconvenience, but in some patients it can cause a severe debilitating condition which sometimes causes one’s life to come to a grinding halt.

Common causes
Common causes of diarrhea include irritable bowel syndrome, poor diet, and inflammatory bowel disease. Many other causes of chronic diarrhea exist, but a gastroenterologist will take a medical history, perform a physical exam, and order certain diagnostic tests to try to elicit a cause for a patient’s diarrhea.

A medical history
often points to the underlying cause of chronic diarrhea. A doctor will ask about the onset of diarrhea, the time of day it occurs, the consistency of the stool, whether any blood can be seen in the stool and alleviating or aggravating factors such as certain foods consumed. Other questions will involve consumption of well or city water, travel outside the USA, medications one takes, previous abdominal surgery or trauma, if urgency is present and if incontinence occurs. Incontinence is the involuntary passage of stool or soiling of undergarments.

Diagnostic tests are often performed when a patient seeks medical attention for chronic diarrhea. The Gastroenterologist will likely perform blood tests first to rule out common causes of diarrhea.

A Chemistry 15 or electrolyte/kidney/liver panel is drawn to detect dehydration or electrolyte deficiencies. If these exist, vitamin or mineral repletion may be necessary.

An absolute blood count is drawn to detect infection or inflammation as a cause for the diarrhea. Patients with inflammatory bowel disease or celiac sprue induced diarrhea often have a low red blood cell count also called an anemia. An anemia in a patient with chronic diarrhea would require further more invasive testing such as EGD or colonoscopy.

A sedimentation rate or C-reactive protein test is also drawn to check for infection/inflammation. This test is quite non-specific, but if it is abnormal, one may order other tests to look for sources of the inflammation such as a colonoscopy to look for IBD (inflammatory bowel disease)

Stool tests may be performed to look for white blood cells. WBCs in the stool point toward infection or inflammation. If WBCs exist in the stool, stool culture to look for specific bacteria can be ordered. If chronic diarrhea is due to a toxin producing bacteria or bacteria itself, antibiotic treatment can be prescribed. Stool fat can be determined in a stool specimen. Malabsorption of fat from damaged GI tract lining (as in pancreatic disease or small intestinal disease) causes fat to accumulate in the stool.The fecal occult blood test detects small amounts of blood in the stool that cannot be seen with a naked eye. The presence of blood in stools suggests that diarrhea is due to infection or inflammation and in very rare cases due to colon cancer.

Colonoscopy allows examination of the lining of the rectum and colon. This test can diagnose disruptions of the lining of the colon which can cause diarrhea such as IBD. Colonoscopy also allows the doctor to take biopsies of the colon lining to be examined under the microscope. Microscopic examination of the colonic lining often yields a diagnosis to explain diarrhea. For example, microscopic colitis can cause up to 10 to 15 diarrheal bowel movements a day and this can be seen within these biopsies.

Upper endoscopy or EGD allows examination of the stomach and the first part of the small intestine. Certain diseases of the small intestine such as celiac disease can be diagnosed to explain chronic diarrhea.

X-ray tests such as a small bowel follow through can be utilized to view all areas of the small intestine. Occasionally an area of ulceration or stricturing of the small intestine can be seen to explain chronic diarrhea from Crohn’s disease. Crohn’s disease is a form of inflammatory bowel disease.

A CT scan can be particularly useful for identifying tumors and changes of the pancreas. Certain pancreatic tumors can cause chronic diarrhea by releasing enzymes into the body which allow fluid to be moved into the GI tract causing copious amounts of diarrhea.

Treatment
Treatment involves diagnosis and treatment of the cause of the diarrhea. Treatment always involves relieving the diarrhea and this can be accomplished in some people by simply adding antidiarrheal drugs such a Pepto Bismol, Imodium or Keopectate.

If the diarrhea is caused by IBD, certain anti-inflammatory agents cna be used to counteract the inflammation and slow down the amount of diarrhea.

If a pancreatic tumor is causing the diarrhea, medications to control the tumor or even surgical resection of the tumor may be necessary.

Chronic or severe diarrhea can lead to potentially serious complications, including dehydration and malnutrition. Rehydration replenishes the fluids and electrolytes lost during large amounts of diarrheal episodes. Your doctor may recommend oral solutions or, in cases of severe diarrhea, intravenous fluids to replenish lost fluids.