Chronic Diarrhea: Diagnosis and Management

Lawrence R. Schiller; Darrell S. Pardi; Joseph H. Sellin


Clin Gastroenterol Hepatol. 2017;15(2):182-193. 

In This Article

What Is the Approach When Initial Efforts Fail to Make a Diagnosis?


24. Failure to make a diagnosis is more likely due to overlooking a common cause than missing a rare cause of chronic diarrhea. Physicians should repeat the history and physical examination and review studies already done before ordering additional tests. Repeating tests only should be done with cause. (2c)

Physicians sometimes fail to make a diagnosis despite an evaluation and may refer such patients to centers interested in this condition.[53] Common diagnoses resulting from reevaluation of these patients are shown in Table 2.

Although unusual or obscure conditions might be expected in these patients, most of the eventual diagnoses are straightforward. Fecal incontinence and iatrogenic diarrhea could be recognized with a careful history. Surreptitious laxative ingestion and microscopic colitis could be diagnosed with appropriate testing (eg, laxative screen and colonic biopsy, respectively). Pancreatic insufficiency, BAM, SIBO, and carbohydrate malabsorption could be discovered with a detailed history and specific testing or properly conducted therapeutic trials. Peptide-secreting tumors are rare, but serum peptide assays and imaging (eg, CT scanning and octreotide scanning) are widely available. Failure to make a diagnosis typically results from failure to appreciate all the available evidence and from not considering the entire differential diagnosis of chronic diarrhea.