Classification of chronic diarrhoea

Classification of chronic diarrhoea (1, 2)

Chronic diarrhoea can be divided into six broad categories.

• osmotic
  • medications e.g. - laxatives
  • undigested sugars e.g. diet foods/drinks/gum
    
    
• secretory
  
  • medications e.g. - non-osmotic laxatives, antibiotics etc
  • small intestinal bacterial overgrowth
  • endocrine e.g. - carcinoid, gastrinoma, adrenal insufficiency, hyperthyroidism
  • bile salt malabsorption e.g. - ileal resection, idiopathic, post cholecystectomy
  • non-invasive infections e.g. - giardiasis, cryptosporidiosis
    
    
• steatorrhoea
  • maldigestion
    • decreased bile salts - cirrhosis, bile duct obstruction, ileal resection
    • pancreatic dysfunction - chronic pancreatitis, cystic fibrosis
  • malabsorption e.g. - Coeliac sprue, tropical sprue, Chronic mesenteric ischaemia, short bowel syndrome
    
    
• inflammatory
  • inflammatory bowel disease e.g. - ulcerative colitis, Crohn's disease,
  • malignancy e.g. - colon cancer, lymphoma
  • radiation colitis
    
    
• motility
  • post-surgical (vagotomy, dumping)
  • scleroderma
  • diabetes
  • hyperthyroidism
    
    
• miscellaneous
  • irritable bowel syndrome
  • fictitious

References:

1. Schiller LR et al. Gastro 2013 APDW/WCOG Shanghai working party report: chronic diarrhea: definition, classification, diagnosis. J Gastroenterol Hepatol. 2014;29(1):6-25.
2. Sweetser S. Evaluating the patient with diarrhoea: a case-based approach. Mayo Clin Proc. 2012 Jun;87(6):596-602