ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day Two) | March 2026-Clinical Vignettes: Approach to Acute and Chronic Diarrhea Including Celiac Sprue and SIBO

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Video Summary

The speaker reviews a practical, stepwise approach to patients presenting with bloating, chronic diarrhea, possible celiac disease, and small-bowel disorders such as SIBO. Celiac disease diagnosis is often delayed about five years after symptom onset. For chronic diarrhea, key alarm features include onset after age 50, rectal bleeding/melena, unexplained weight loss, and iron-deficiency anemia (all of the above).<br /><br />Bloating has a broad differential (dietary intolerances/high-FODMAP foods, constipation/pelvic floor dysfunction, celiac disease, SIBO, gastroparesis, obstruction, pancreatic insufficiency, hypothyroidism, ascites, prior surgeries, malignancy, aerophagia). The speaker emphasizes careful history-taking and avoiding premature SIBO testing/treatment, as breath tests and rifaximin can be costly and dietary triggers may be the real cause.<br /><br />Celiac disease can present with classic GI symptoms or non-classic manifestations (iron deficiency, osteoporosis, elevated liver enzymes, rash, headaches, psychiatric symptoms). Testing should include tTG-IgA plus total IgA (use IgG-based tests if IgA-deficient) and must be done while eating gluten; biopsy via upper endoscopy is recommended. Management requires lifelong gluten-free diet, dietitian support, monitoring serologies and micronutrients, and repeat endoscopy if symptoms persist.<br /><br />Chronic diarrhea (>30 days) is categorized (malabsorptive, secretory, osmotic, inflammatory, motility-related). Workup includes stool studies, labs, and often colonoscopy with random biopsies to diagnose conditions like microscopic colitis (associated with PPIs/SSRIs/NSAIDs). SIBO is diagnosed by breath testing and treated based on gas pattern (hydrogen vs methane), often triggered by prior surgery or altered anatomy.

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Jill Olmstead, DNP, ANP-BC, FAANP

Meta Tag

Concept Celiac Disease

Concept Tissue Transglutaminase IgA

Concept Chronic Diarrhea

Concept Gluten-Free Diet

Concept Diarrhea

Keywords

chronic diarrhea alarm features

bloating differential diagnosis

celiac disease testing tTG-IgA total IgA

gluten-free diet management and monitoring

small intestinal bacterial overgrowth (SIBO) breath test

microscopic colitis colonoscopy random biopsies

malabsorptive secretory osmotic inflammatory diarrhea classification

Celiac Disease

Tissue Transglutaminase IgA

Chronic Diarrhea

Gluten-Free Diet

Diarrhea