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

How Is Chronic Diarrhea Defined?


1. Patients define diarrhea as loose stools, increased stool frequency, or urgency; physicians should note precisely what the patient means. (1b)

2. Chronic diarrhea is defined by a duration of >4 weeks. (2b)

Diarrhea can refer to urgency or high stool frequency, although most patients use the term to describe changes in consistency (loose or watery stools).[3] In fact, frequent defecation with normal consistency is termed pseudodiarrhea; therefore, abnormal stool form and not frequency should be used to define diarrhea.

Most diarrheal episodes in developed countries are acute and self-limited and are usually due to infections. In immunocompetent patients, acute infectious diarrhea typically resolves within 4 weeks (most commonly within 1 week). Therefore, chronic diarrhea is defined as that lasting longer than 4 weeks. It is estimated that 1%–5% of adults suffer from chronic diarrhea.[4] In immunocompetent patients in developed countries, chronic diarrhea is generally not infectious. The challenge in managing these patients is the fact that the differential diagnosis is vast. However, a careful history and thorough physical examination with judicious use of selected tests often lead to a specific diagnosis and an appropriate treatment plan.