Table of contents

Chronic diarrhea


Key sources

The following summarized guidelines for the evaluation and management of chronic diarrhea are prepared by our editorial team based on guidelines from the Canadian Association of Gastroenterologists (CAG 2020), the American Gastroenterological Association (AGA 2019), the British Society of Gastroenterology (BSG 2018), the Chronic Diarrhea Expert Group (CD-EG 2017), the American College of Gastroenterology (ACG 2013), and the American Society ...
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Screening and diagnosis

As per CD-EG 2017 guidelines:
Recognize that patients report diarrhea as loose stools, increased stool frequency, or urgency.
Define chronic diarrhea by the duration of > 4 weeks.
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Diagnostic investigations

Initial evaluation: as per BSG 2018 guidelines, elicit a detailed history to plan investigations in patients with chronic diarrhea.
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More topics in this section

  • Evaluation for IBD

  • Evaluation for malabsorption

  • Evaluation for celiac disease

  • Evaluation for bile acid diarrhea

  • Evaluation of SIBO

  • Evaluation for pancreatic insufficiency

  • Evaluation for parasites

  • Evaluation for IBS

  • Evaluation for CRC

  • Evaluation for hormone-secreting tumors

  • Evaluation for structural disorders

  • Evaluation for GvHD

Medical management

Non-specific management: as per CD-EG 2017 guidelines, offer opioid antidiarrheals (scheduled rather than as needed) for symptomatic management when specific treatment is not possible.

Specific circumstances

Patients with HIV
As per ASGE 2010 guidelines:
Consider performing flexible sigmoidoscopy or colonoscopy in patients with HIV and diarrhea if laboratory evaluation is nondiagnostic.
Perform a full colonoscopy with biopsy and/or upper gastrointestinal endoscopy with biopsy in patients with HIV and persistent diarrhea if flexible sigmoidoscopy is nondiagnostic.

Follow-up and surveillance

Indications for referral: as per BSG 2018 guidelines, refer patients for further investigations if symptoms persist despite normal first-line investigations and treatment.