Study note

Chronic or relapsing diarrhoea: clinical patterns, causes and investigations

THE CONTEXT
The table compares colonic diarrhoea, malabsorption and small bowel diarrhoea.

Colonic diarrhoea

FeatureDetails
Clinical features
Blood and mucus in the stool occur with cramping lower abdominal pain.
Causes
Listed causes are inflammatory bowel disease, microscopic colitis, neoplasia, ischaemia and irritable bowel syndrome.
Investigations
Faecal calprotectin and ileocolonoscopy with biopsies are listed.

Malabsorption

FeatureDetails
Clinical features
Steatorrhoea, undigested food in the stool, weight loss and nutritional disturbances are listed.
Pancreatic causes
Chronic pancreatitis, cancer of the pancreas and cystic fibrosis are listed.
Enteropathy causes
Coeliac disease, tropical sprue, lymphoma and lymphangiectasia are listed.
Investigations
Listed tests are faecal elastase; ultrasound, computed tomography and magnetic resonance cholangiopancreatography; small bowel biopsy; and barium follow-through or small bowel magnetic resonance imaging.

Small bowel diarrhoea

FeatureDetails
Clinical features
Large-volume watery stool, abdominal bloating and cramping mid-abdominal pain are listed.
Causes
Listed causes include Crohn disease, neuroendocrine tumour, small bowel carcinoid and VIPoma.
Drug-induced causes
Non-steroidal anti-inflammatory drugs, aminosalicylates and selective serotonin re-uptake inhibitors are listed.
Investigations
Listed tests are faecal calprotectin, stool volume, serum gut hormone profile, 24-hour urine 5-hydroxyindoleacetic acid, and barium follow-through or small bowel magnetic resonance imaging.
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