Chronic Diarrhoea

Chronic Diarrhoea

Coeliac Disease


Pathology:                Immune-mediated destruction of villi in the proximal small bowel due to exposure to gluten, usually diagnosed in childhood, can present in adulthood with anaemia or new onset diarrhoea in adulthood


Aetiology:                 Commonest in white Europeans. Associated with other autoimmune disorders such

as Type 1 Diabetes, IgA deficiency, Sjögren Syndrome, Rheumatoid Arthritis


Symptoms:               Lethargy, steatorrhoea, diarrhoea, frothy foul smelling stool, weight loss, vitamin deficiency, iron deficiency, osteoporosis


Signs:                          Pallor, dermatitis herpetiformis (itchy rash on extensor surfaces), distended abdomen, mouth ulcers


Investigations:      Bloods: FBC, U&E

Auto-Antibody Screen:  Tissue Transglutamase and Anti-endomysial positive

OGD: Duodenal biopsies show villous atrophy and crypt hyperplasia


Treatment:              Conservative: Gluten free diet

                                        Medical: Steroids and immunosuppression for refractory disease


Complications:      Susceptibility to GI malignancy, T-Cell lymphoma, Anaemia, Osteoporosis


Prognosis:                70% improve within 2 weeks of a gluten free diet.


















Figure 3.3 Dermatitis Herpetiformis


Irritable Bowel Syndrome


Pathology:                Chronic relapsing functional bowel disorder, constipation predominant, diarrhoea predominant or alternate between the two.


Aetiology:                 Unknown, IBS is common, highest prevalence in young women

Altered motility and visceral hypersensitivity are implicated in causing the symptoms of IBS


Symptoms:               Diarrhoea, constipation, abdominal pain, bloating, relieved by defecation, passing mucous, increased flatulence


Signs:                          Abdominal bloating, Sensation of incomplete defecation



Investigations:      Bloods: FBC, U&E, TFTs, Faecal Calprotectin – marker of bowel inflammation

Auto-Antibody Screen: Tissue Transglutamase and Anti-endomysial negative

Microbiology: Stool culture


Treatment:              Conservative: Lifestyle advice

Medical: Antispasmodics for pain, anti-diarrhoeal agents, laxatives


Complications:      Can lead to anxiety and depression


Prognosis:                50% improve after 1 year.















Pathology:               Defined as hard stools with straining on defecation, sensation of incomplete evacuation and fewer than three defecations per week


Aetiology:                 Increased age, inadequate fibre, drugs (opiates, anticholinergics, iron), slow bowel transit, constipation, spinal cord lesions, Hirschsprung’s disease, Chagas’ disease, autonomic neuropathy, hypothyroidism, hypercalcaemia, hypopituitarism, Addison’s disease


Symptoms:               Straining, sensation of incomplete evacuation, requiring manoeuvres to open bowels, manual evacuation


Signs:                          Tenesmus


Investigations:      Bloods: FBC, U&E, LFT, TFTs and Calcium

Imaging: Colonic transit study


Treatment:              Conservative: Lifestyle advice and increased dietary fibre

Medical: Laxatives


Complications:      Anal fissure, chronic haemorrhoids, faecal impaction


Prognosis:                Good prognosis with treatment


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