腹泻可被定义为：[1]World Health Organization. Health topics - diarrhoea. 2017 [internet publication].
http://www.who.int/topics/diarrhoea/en
[2]Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016 May;111(5):602-22.
http://www.spg.pt/wp-content/uploads/2015/07/2016-acute-diarrhea.pdf
http://www.ncbi.nlm.nih.gov/pubmed/27068718?tool=bestpractice.com
根据病程，腹泻分为：[2]Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016 May;111(5):602-22.
http://www.spg.pt/wp-content/uploads/2015/07/2016-acute-diarrhea.pdf
http://www.ncbi.nlm.nih.gov/pubmed/27068718?tool=bestpractice.com
[3]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.
https://gut.bmj.com/content/67/8/1380.long
http://www.ncbi.nlm.nih.gov/pubmed/29653941?tool=bestpractice.com
[4]World Gastroenterology Organisation. Acute diarrhea in adults and children: a global perspective. 2012 [internet publication].
http://www.worldgastroenterology.org/guidelines/global-guidelines/acute-diarrhea/acute-diarrhea-english
[5]Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):e45-80.
https://academic.oup.com/cid/article/65/12/e45/4557073
http://www.ncbi.nlm.nih.gov/pubmed/29053792?tool=bestpractice.com
流行病学
2016 年，腹泻是所有年龄段的第 8 大死因，是 5 岁以下儿童的第 5 大死因。[6]GBD 2016 Diarrhoeal Disease Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018 Nov;18(11):1211-28.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202444
http://www.ncbi.nlm.nih.gov/pubmed/30243583?tool=bestpractice.com
在世界范围内，每年估计有 20 亿次腹泻发作。[4]World Gastroenterology Organisation. Acute diarrhea in adults and children: a global perspective. 2012 [internet publication].
http://www.worldgastroenterology.org/guidelines/global-guidelines/acute-diarrhea/acute-diarrhea-english
腹泻所致死亡不成比例的累及 <5 岁新生后儿童。[4]World Gastroenterology Organisation. Acute diarrhea in adults and children: a global perspective. 2012 [internet publication].
http://www.worldgastroenterology.org/guidelines/global-guidelines/acute-diarrhea/acute-diarrhea-english
然而，随着口服补液治疗（oral rehydration therapy, ORT）、维生素补剂、轮状病毒疫苗，以及喂养和断奶宣教的实施，据估计，死亡例数已从 1967 年的 390 万人下降至 2015 年的 52.6 万人。[7]Black R, Fontaine O, Lamberti L, et al. Drivers of the reduction in childhood diarrhea mortality 1980-2015 and interventions to eliminate preventable diarrhea deaths by 2030. J Glob Health. 2019 Dec;9(2):020801.
https://pubmed.ncbi.nlm.nih.gov/31673345
http://www.ncbi.nlm.nih.gov/pubmed/31673345?tool=bestpractice.com
另外，新型止泻药物与 ORT 联合应用，对于减少腹泻容量负担呈现出较好的前景。[8]Eberlin M, Chen M, Mueck T, et al. Racecadotril in the treatment of acute diarrhea in children: a systematic, comprehensive review and meta-analysis of randomized controlled trials. BMC Pediatr. 2018 Apr 3;18(1):124.
https://www.doi.org/10.1186/s12887-018-1095-x
http://www.ncbi.nlm.nih.gov/pubmed/29614995?tool=bestpractice.com
尽管情况有所改善，但腹泻仍然是 <5 岁新生儿童产后死亡的第 3 大原因，仅次于肺炎和早产/新生儿疾病。[9]Centers for Disease Control and Prevention. Global diarrhea burden. Dec 2015 [internet publication].
https://www.cdc.gov/healthywater/global/diarrhea-burden.html
[10]World Health Organization. Children: reducing mortality. Oct 2017 [internet publication].
http://www.who.int/mediacentre/factsheets/fs178/en
在美国，每年大约发生 4780 万例急性腹泻感染病例，医疗保健支出估计至少 1.5 亿美元。[11]Scallan E, Griffin PM, Angulo FJ, et al. Foodborne illness acquired in the United States: unspecified agents. Emerg Infect Dis. 2011 Jan;17(1):16-22.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204615
http://www.ncbi.nlm.nih.gov/pubmed/21192849?tool=bestpractice.com
[12]Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States: major pathogens. Emerg Infect Dis. 2011 Jan;17(1):7-15.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375761
http://www.ncbi.nlm.nih.gov/pubmed/21192848?tool=bestpractice.com
与之相比，英格兰和威尔士，每年感染肠道疾病导致{\f3 300}人死亡和{\f3 35,000}例住院治疗。[13]Wheeler JG, Sethi D, Cowden JM, et al; The Infectious Intestinal Disease Study Executive. Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance. BMJ. 1999 Apr 17;318(7190):1046-50.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27838
http://www.ncbi.nlm.nih.gov/pubmed/10205103?tool=bestpractice.com
据估计，英国每年有 1700 万例急性感染性腹泻，其中全科医生接诊 100 万例。[14]Tam CC, Rodrigues LC, Viviani L, et al; IID2 Study Executive Committee. Longitudinal study of infectious intestinal disease in the UK (IID2 study): incidence in the community and presenting to general practice. Gut. 2012 Jan;61(1):69-77.
http://gut.bmj.com/content/61/1/69.long
http://www.ncbi.nlm.nih.gov/pubmed/21708822?tool=bestpractice.com
病理生理学基本特征
除外唾液腺、胃、胰腺、胆管和十二指肠的分泌物，通常每天约由摄取的食物和饮料组成10L液体进入胃肠道。 小肠是重吸收的主要场所。 总体而言，约 99% 的液体被重新吸收，留下 0.1 L 经粪便排泄。 腹泻在各种因素干扰正常进程时就会发生，导致液体和电解质吸收减少或者液体和电解质分泌的增加，或者增加肠道的动力。
增加传染性腹泻病理生理和促使引起致病因子传播的因素的理解，将有助于对疾病暴发做出阻止和反应。[15]Pawlowski SW, Warren CA, Guerrant R. Diagnosis and treatment of acute or persistent diarrhea. Gastroenterology. 2009 May;136(6):1874-86.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723735
http://www.ncbi.nlm.nih.gov/pubmed/19457416?tool=bestpractice.com
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