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In medicine, diarrhea, also spelled diarrhoea (see spelling differences), is frequent loose or liquid bowel movements. Acute diarrhea is a common cause of death in developing countries and the second most common cause of infant deaths worldwide.

Diarrhea
Specialty	Infectious diseases, gastroenterology

Causes

Diarrhea commonly results from gastroenteritis caused by viral infections, parasites or bacterial toxins. In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy patient usually recovers from viral infections in a few days. However, for ill or malnourished individuals diarrhea can lead to severe dehydration and can become life-threatening without treatment.

Diarrhea can also be a symptom of more serious diseases, such as dysentery, cholera, or botulism, and can also be indicative of a chronic syndrome such as Crohn's disease or severe mushroom poisoning syndromes. Though appendicitis patients do not generally have violent diarrhea, it is a common symptom of a ruptured appendix. It is also an effect of severe radiation sickness.

Diarrhea can also be caused by dairy intake in those who are lactose intolerant.

Symptomatic treatment for diarrhea involves the patient consuming adequate amounts of water to replace that loss, preferably mixed with electrolytes to provide essential salts and some amount of nutrients. For many people, further treatment is unnecessary. The following types of diarrhea indicate medical supervision is required:

• Diarrhea in infants
• Moderate or severe diarrhea in young children;
• Diarrhea associated with blood
• Diarrhea that continues for more than two days;
• Diarrhea that is associated with more general illness such as non-cramping abdominal pain, fever, weight loss, etc;
• Diarrhea in travelers, since they are more likely to have exotic infections such as parasites;
• Diarrhea in food handlers, because of the potential to infect others;
• Diarrhea in institutions such as hospitals, child care centers, or geriatric and convalescent homes.

A severity score is used to aid diagnosis in children.

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Infectious diarrhea

Infectious diarrhea is diarrhea caused by a microbe such as a bacterium, parasite, or virus.

Malabsorption

Malabsorption is the inability to absorb food, mostly in the small bowel but also due to the pancreas.

Causes include celiac disease (intolerance to wheat, rye, and barley gluten, the protein of the grain), lactose intolerance (intolerance to milk sugar, common in non-Europeans), fructose malabsorption, pernicious anemia (impaired bowel function due to the inability to absorb vitamin B12), loss of pancreatic secretions (may be due to cystic fibrosis or pancreatitis), short bowel syndrome (surgically removed bowel), radiation fibrosis (usually following cancer treatment), and other drugs, including agents used in chemotherapy.

Inflammatory bowel disease

The two overlapping types here are of unknown origin:

• Ulcerative colitis is marked by chronic bloody diarrhea and inflammation mostly affects the distal colon near the rectum.
• Crohn's disease typically affects fairly well demarcated segments of bowel in the colon and often affects the end of the small bowel.

Irritable Bowel Syndrome

Another possible cause of diarrhea is Irritable Bowel Syndrome (IBS). Symptoms defining IBS: abdominal discomfort or pain relieved by defecation and unusual stool (diarrhea or constipation or both) or stool frequency, for at least 3 days a week over the previous 3 months. IBS symptoms can be present in patients with a variety of conditions including food allergies, infective diarrhea, celiac, and inflammatory bowel diseases. Treating the underlying condition (celiac disease, food allergy, bacterial dysbiosis, etc.) usually resolves the diarrhea. IBS can cause visceral hypersensitivity. While there is no direct treatment for undifferentiated IBS, symptoms, including diarrhea, can sometimes be managed through a combination of dietary changes, soluble fiber supplements, and/or medications.

It is important to note that IBS can often be confused with Giardiasis since false negative tests for giardia can result in a misdiagnoses of the actual cause, a parasitic infection.

Other important causes

• Ischemic bowel disease. This usually affects older people and can be due to blocked arteries.
• Bowel cancer: Some (but not all) bowel cancers may have associated diarrhea. Cancer of the large intestine is most common.
• Hormone-secreting tumors: some hormones (e.g. serotonin) can cause diarrhea if excreted in excess (usually from a tumor).
• Bile salt diarrhea: excess bile salt entering the colon rather than being absorbed at the end of the small intestine can cause diarrhea, typically shortly after eating. Bile salt diarrhea is a bad side-effect of gallbladder removal. It is usually treated with cholestyramine, a bile acid sequestrant.
• Celiac Disease
• Intestinal Protozoa such as Giardiasis

Alcohol

Chronic diarrhea can be caused by chronic ethanol ingestion. Consumption of alcohol affects the body's capability to absorb water - this is often a symptom that accompanies a hangover after a heavy drinking session. The alcohol itself is absorbed in the intestines and as the intestinal cells absorb it, the toxicity causes these cells to lose their ability to absorb water. This leads to an outpouring of fluid from the intestinal lining, which is in turn poorly absorbed. The diarrhea usually lasts for several hours until the alcohol is detoxified and removed from the digestive system. Symptoms range from person to person and are influenced by both the amount consumed as well as physiological differences.

Treatment

In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. Medicines that are available without a doctor's prescription include loperamide (Imodium) and bismuth subsalicylate (as found in Pepto Bismol and Kaopectate).

See also

• Constipation
• Drinking water
• Feces
• Steatorrhea (fatty diarrhea)
• Traveler's diarrhea
• Wilderness diarrhea
• Food poisoning
• The Diarrhea Song
• Shigella
• Rotavirus
• ETEC

Footnotes

1. Wilson ME (2005). "Diarrhea in nontravelers: risk and etiology". Clin. Infect. Dis. 41 Suppl 8: S541–6. doi:10.1086/432949. PMID 16267716.
2. Alam NH, Ashraf H (2003). "Treatment of infectious diarrhea in children". Paediatr Drugs. 5 (3): 151–65. PMID 12608880.
3. Ruuska T, Vesikari T (1990). "Rotavirus disease in Finnish children: use of numerical scores for clinical severity of diarrhoeal episodes". Scand. J. Infect. Dis. 22 (3): 259–67. doi:10.3109/00365549009027046. PMID 2371542.
4. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006). "Functional bowel disorders". Gastroenterology. 130 (5): 1480–91. doi:10.1053/j.gastro.2005.11.061. PMID 16678561.{{cite journal}}: CS1 maint: multiple names: authors list (link)
5. Wangen, S. "The Irritable Bowel Syndrome Solution". page 113. 2006; Innate Health Publishing. ISBN 978-0-9768537-8-7. Excerpted with the author's permission at http://www.IBSTreatmentCenter.com
6. ^ Intestinal Protozoa
7. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 2005. ISBN 0-07-139140-1.
8. Schiller LR (2007). "Management of diarrhea in clinical practice: strategies for primary care physicians". Rev Gastroenterol Disord. 7 Suppl 3: S27–38. PMID 18192963.

External links

• Victora CG, Bryce J, Fontaine O, Monasch R (2000). "Reducing deaths from diarrhoea through oral rehydration therapy". Bull. World Health Organ. 78 (10): 1246–55. PMID 11100619.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Parashar UD, Bresee JS, Glass RI (2003). "The global burden of diarrhoeal disease in children". Bull. World Health Organ. 81 (4): 236. doi:10.1590/S0042-96862003000400003. PMID 12764488.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Travelers' Diarrhea
• Rehydration Project

• Gastroenterology
• Water-borne diseases
• Symptoms
• Digestive disease symptoms
• Conditions diagnosed by stool test