Three or more loose or liquid stools per 24 hours, and/or
Stools that are more frequent than what is normal for the individual lasting <14 days, and/or
Stool weight greater than 200 g/day.
Acute (≤14 days)
Persistent (>14 days), or
Chronic (>4 weeks).
In 2016, diarrhoea was the eighth leading cause of death among all ages and the fifth leading cause of death among children younger than 5 years.
Worldwide, it has been estimated that there are 2 billion episodes of diarrhoeal illness per year. Death due to diarrhoea disproportionately affects postneonatal children <5 years. However, with implementation of improved access to oral rehydration therapy (ORT), vitamin supplementation, rotavirus vaccines, and education on feeding and weaning, it is estimated that mortality has dropped from 3.9 million deaths in 1967 to 526,000 in 2015. Additionally, new antisecretory agents have shown promise in conjunction with ORT to reduce diarrhoea volume burden. Despite the improvement, diarrhoea remains the third leading cause of death in postneonatal children <5 years, after pneumonia and preterm birth/neonatal disorders.
Around 47.8 million cases of acute diarrhoeal infection occur each year in the US, with an estimated cost of at least US$150 million to the healthcare economy. This compares to England and Wales, where infectious intestinal disease causes 300 deaths and 35,000 hospital admissions annually. There are an estimated 17 million cases and 1 million consultations with a general practitioner attributed to acute infectious diarrhoea in the United Kingdom every year.
Normally approximately 10 litres of fluid consisting of ingested food and drink, in addition to secretions from the salivary glands, stomach, pancreas, bile ducts, and duodenum, enters the gastrointestinal tract every day. The small intestine is the major site for re-absorption. Overall, about 99% of the fluid is re-absorbed, leaving 0.1 litre to be excreted in the faeces. Diarrhoea occurs when various factors interfere with this normal process, resulting in decreased absorption or increased secretion of fluid and electrolytes, or increase in bowel motility.
Improved understanding of the pathophysiology of infectious diarrhoea, and the factors that promote the spread of causative infectious agents, will lead to practical approaches for preventing and responding to outbreaks.
- Enteric adenovirus
- Campylobacter enteritis (Campylobacter jejuni and Campylobacter coli)
- Escherichia coli (enterotoxigenic, enteropathogenic, enteroinvasive, enterohaemorrhagic, enteroaggregative)
- Clostridium difficile
- Vibrio cholerae
- Staphylococcus aureus
- Bacillus cereus
- Clostridium perfringens
- Entamoeba histolytica
- Ulcerative colitis
- Crohn's disease
- Irritable bowel syndrome
- Cystoisospora belli
- Klebsiella oxytoca
- Bowel ischaemia
- Radiation injury
- Clinical practice guideline: 2021 focused update guidelines on management of Clostridioides difficile infection in adults
- Clinical practice guidelines for
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