Diarrhoea - Chronic
There are A LOT of causes of chronic diarrhoea. So many that I am
sure I will miss a number of them in the following list, but here
goes: malabsorptive diseases (anything causing an inability to
absorb food, such as wheat gluten sensitivity or
plasmacytic-lymphocytic enteritis), maldigestion syndromes such as
pancreatic insufficiency, inflammatory bowel disease, intestinal
parasites (protozoans, worms, coccidia), fungal infections (rarely),
damage to vital organs such as the liver or kidney leading to
secondary diarrhoea problems, diabetes mellitus,
hypoadrenocorticism, small intestinal bacterial overgrowth, cancer,
ulcers, bacterial enteritis or colitis, cecal inversion and
irritable bowel syndromes.
It is important to try to decide if this is a small intestinal
problem or large intestinal problem. In small intestinal disease the
diarrhoea tends to be pretty large volume at one time but less
frequent episodes of diarrhoea. In large intestinal diarrhoea the
volume of diarrhoea tends to be smaller but episodes are more
frequent. Knowing which of these is likely to be the problem helps
in deciding which tests to run.
In chronic diarrhoea it can be very hard to find a diagnosis. The
intestinal biopsies were are very good idea. It is too bad they were
not more informative. It can take multiple fecal exams to find some
parasites, particularly giardia and whipworms. There are pretty good
blood tests now to aid in the diagnosis of pancreatic insufficiency
(blood trypsin-like immunoreactivity, folate levels, it is always
wise to do general lab panels to make sure other organ systems are
functioning properly. It can be helpful to rule out food
sensitivity/allergy using special diets (elimination diets). Culture
of the stool will sometimes reveal a bacteria that is very likely to
be pathogenic, such as Salmonella or Clostridium perfringens.
Special cultures can be done for Campylobacter.
If sulfasalazine does help, that is a hint that the problem is
likely to be in the large intestine. If biopsies did not include the
colon it may be possible to obtain the necessary biopsy samples from
the colon to make a diagnosis using an endoscope with a biopsy
forceps.
In most cases, it is possible to find a cause for the diarrhoea and
to successfully treat it, if you are patient enough. You can tell
from the long list of possible causes that it can be hard, though.
