Osmotic laxatives: e.g., magnesium citrate.Poor absorption or excessive ingestion of hydrophilic substances (e.g., salts, sugars, laxatives) causes water to be drawn into the intestinal lumen.Viruses: e.g., norovirus, rotavirus, adenovirus.Protozoa: e.g., giardiasis, cryptosporidiosis.difficile (associated with antibiotic and PPI use) Active secretion of water into the intestinal lumen via inhibition or activation of enzymes (e.g., ↑ cAMP activity).Lack of digestive enzymes → impaired breakdown of food in the intestinal lumen → malabsorption of carbohydrates, proteins, fats, fat-soluble vitamins (A, D, E, K), and vitamin B 12.Small intestinal bacterial overgrowth ( SIBO).Malabsorption disorders or history of ileal resection.Alterations of the intestinal mucosa → impaired absorption of digested food.Clostridioides difficile (rarely bloody).Amebiasis ( amebic dysentery caused by Entamoeba histolytica).Enteroinvasive Escherichia coli, enterohemorrhagic E.Mucus, blood, and leukocytes present in the stool.Damage to the intestinal mucosa may cause cytokine -induced water hypersecretion, impair absorption of osmotically active substances or fat, and/or disrupt water and electrolyte absorption.Amebic cysts are excreted in stool and can contaminate drinking water or food.Ĭlassification of diarrhea by functional pathology.Yersiniosis (outbreaks often occur in day-care settings).Reservoir: contaminated pork and milk products.Low infectious dose required ( low ID 50).Hosts: humans, animals, and animal products (e.g., reptiles, poultry, pets, eggs).Commonly precedes reactive arthritis and Guillain‑Barré syndrome.Campylobacter enteritis (especially in children).Curved or spiral‑shaped with polar flagellum.Direct invasion of the intestinal epithelium and formation of enterotoxins.Immunocompromised individuals: potentially life-threatening protracted diarrhea and/or biliary tract infections (e.g., cholangitis, cholecystitis).Fecal-oral transmission (oocysts are typically excreted in stool and contaminate drinking water).Most commonly affects hikers or campers.Transmission via ingestion of contaminated water (e.g., lakes, rivers, ponds, swimming pools).Transmission via contaminated water or fecal-oral route.Prevention: attenuated vaccine for children.Transmission via contaminated water or uncooked seafood (e.g., raw shellfish).Cholera toxin ( enterotoxin): “ rice water” diarrhea.Curative treatment is directed toward the underlying cause. Ensuring adequate oral hydration, correcting dehydration, and providing symptomatic relief are fundamental components in the care of all patients with diarrhea.
The presence of any red flags for severe or rapidly progressing diarrheal disease (e.g., sepsis, extreme dehydration, blood in the stool) mandates escalation of testing and, in some cases, empiric antibiotics for bacterial gastroenteritis. A thorough history followed by systematic stool and blood testing is required to identify the specific etiology.
Chronic diarrhea, defined as diarrhea lasting longer than 30 days, has an extensive differential diagnosis. Persistent diarrhea, lasting 15–30 days, is also typically caused by an infectious agent, but stool testing for pathogens is generally warranted to confirm the diagnosis. Testing is seldom required, as the disease tends to be self-limited and care is primarily supportive. Acute diarrhea lasts 14 days or less and is almost always caused by an infectious agent, typically a virus. Diarrhea, defined as three or more loose stools per day or more frequent stool passage than is normal for the individual, is a common disease with a monthly prevalence of around 5% in the United States.
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