Algorithm for the Evaluation of Chronic Diarrhea (< 7 days)

Exclude:

1. Causes of acute diarrhea

2. Lactose intolerance

3. Irritable bowel syndrome

4. Previous gastric surgery or ileal resection

5. Parasitic infections

6. Medications

7. Systemic disease

 - Fecal leukocytes and occult blood

 - Colonoscopy with biopsy

 - Small bowel imaging with barium, CT, or MR enterography

 - Stool electrolytes, osmolality, weight/24 h, quantitative fat



Increased fecal fat: Malabsorption syndromes, Pancreatic insufficiency, Bacterial overgrowth

Normal fecal fat: Lactose intolerance, Sorbitol, lactulose, Laxative abuse

Normal stool weight: Irritable bowel syndrome, Factitious diarrhea

Increased stool weight: Secretory laxative abuse (1000 g/24 h)



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