Evaluation of chronic diarrhea

Last reviewed: 13 Apr 2025
Last updated: 28 Apr 2023

Summary

Differentials

Common

  • Ulcerative colitis
  • Microscopic colitis (lymphocytic colitis and collagenous colitis)
  • Viral, bacterial, parasitic, HIV enteropathy
  • Irritable bowel syndrome
  • Drug effects
  • Fecal impaction
  • Celiac disease
  • Crohn disease
  • Bile salt malabsorption
  • Brush border enzyme deficiency (lactose, fructose, sucrose, isomaltase)
  • Small intestinal bacterial overgrowth
  • Pancreatic insufficiency
  • Alcohol
  • Hyperthyroidism
  • Diabetes mellitus
  • Radiation enteritis/colitis
  • Eosinophilic enteritis
  • Chronic ischemic colitis
  • Surgical bypass or resection
Full details

Uncommon

  • Nonsteroidal anti-inflammatory drug enteropathy
  • Infiltrating malignancy
  • Protein-losing enteropathy
  • Graft versus host disease
  • Hodgkin lymphoma
  • Non-Hodgkin lymphoma
  • Tropical sprue
  • Lymphangiectasia/impaired lymphatic drainage
  • Hypoparathyroidism
  • Addison disease
  • Gastrinoma
  • Carcinoid tumors
  • VIPomas
  • Abetalipoproteinemia
  • Advanced liver disease
  • Common variable immune deficiency
  • Amyloidosis
Full details

Contributors

Authors

Consultant Gastroenterologist

Honorary Senior Lecturer

University of Manchester

Manchester

UK

Disclosures

SC declares that he has no competing interests.

Consultant Gastroenterologist

Royal Infirmary Edinburgh

Little France Crescent

Edinburgh

UK

Disclosures

RK is the author of a reference cited in this topic. RK declares that he has no competing interests.

Dr Simon Campbell and Dr Rahul Kalla would like to gratefully acknowledge Dr Abhishek Sharma, Dr Daniel Leffler, and Dr Ciaran Kelly, the previous contributors to this topic. AS has received honoraria for educational presentations, chairing educational sessions, or advisory work from Abbvie, Vifor Pharma, Almirall, Falk, and Warner Chilcott UK. DL and CK are the authors of a number of references cited in this topic.

Peer reviewers

Director

Trauma Services

Assistant Professor

Michigan State University

Lansing

MI

Disclosures

JK declares that he has no competing interests.

Professor of Gastroenterology

Imperial College London

Hammersmith Hospital

London

UK

Disclosures

JRFW has been a member of advisory boards and has received fees for arranging an educational programme from GE Healthcare, the manufacturer of 75SeHCAT. He is a member of the Health Advisory Network for Coeliac UK.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Fernández-Bañares F, Esteve M, Salas A, et al. Systematic evaluation of the causes of chronic watery diarrhea with functional characteristics. Am J Gastroenterol. 2007;102:2520-2528. Abstract

Arasaradnam RP, Brown S, Forbes A, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut. 2018 Aug;67(8):1380-99.Full text  Abstract

Talley NJ. Functional Gastrointestinal Disorders in 2007 and Rome III: something new, something borrowed, something objective. Rev Gastroenterol Disord. 2007;7:97-105. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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