title: Pathophysiology, Evaluation, and Management of Chronic Watery Diarrhea.
abstract: Chronic watery diarrhea poses a diagnostic and therapeutic challenge and is often a disabling condition for patients. Although acute diarrhea is likely to be caused by infection, the causes of chronic diarrhea (>4 weeks in duration) are more elusive. We review the pathophysiology, diagnosis, and treatment of chronic diarrhea. Drawing on recent insights into the molecular mechanisms of intestinal epithelial transport and barrier function, we discuss how diarrhea can result from a decrease in luminal solute absorption, an increase in secretion, or both, as well as derangements in barrier properties. We also describe the various extraepithelial factors that activate diarrheal mechanisms. Finally, clinical evaluation and tests used in the assessment of patients presenting with chronic diarrhea are reviewed, and an algorithm guiding therapeutic decisions and pharmacotherapy is presented.
authors: Clinical Enteric Neuroscience Translational and Epidemiological Research, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: camilleri.michael@mayo.edu.
authors: Michael
authors: M
authors: Camilleri
authors: Division of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors: Joseph H
authors: JH
authors: Sellin
authors: Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, California.
authors: Kim E
authors: KE
authors: Barrett
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism; D002864:Chromogranins / Q000378:metabolism; D002908:Chronic Disease; D003967:Diarrhea / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy; D005243:Feces / Q000737:chemistry; D005769:Gastrointestinal Motility; D006801:Humans; D007249:Inflammation; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism*; D007419:Intestinal Secretions; D007422:Intestines / Q000503:physiopathology; D043183:Irritable Bowel Syndrome / Q000378:metabolism; D007781:Lactoferrin / Q000378:metabolism; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism; D009994:Osmolar Concentration; D010539:Permeability; D011453:Prostaglandins / Q000378:metabolism; D012701:Serotonin / Q000378:metabolism; D013373:Substance P / Q000378:metabolism
chemical_list: D002864:Chromogranins; D039841:Leukocyte L1 Antigen Complex; D011453:Prostaglandins; D012701:Serotonin; D013373:Substance P; D002097:C-Reactive Protein; D007781:Lactoferrin
keywords: Diarrhea; Management; Pathophysiology