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BO_Pardi Chronic Diarrhea

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The document presents a comprehensive approach to managing chronic diarrhea, led by Darrell S. Pardi, MD, MS, who outlines strategies for diagnosis and treatment. Chronic diarrhea, affecting 1-5% of the adult population, substantially impacts quality of life and incurs significant healthcare costs. The differential diagnosis is broad, and various tests are available, yet they can be costly and sometimes lack strong research backing.<br /><br />A structured approach involves understanding the patient’s history and symptoms carefully, considering dietary influences, medications, and personal health history to narrow down potential causes. Chronic diarrhea is defined by over four weeks of symptoms, with patients commonly experiencing more than three mushy or watery bowel movements per day.<br /><br />Diagnostic tests include blood and stool tests, radiology, endoscopy, biopsies, and breath tests. The document highlights various potential causes such as small bowel issues, osmotic or secretory diarrhea, inflammatory conditions like inflammatory bowel disease (IBD), and malabsorption issues. Identifying the nature of diarrhea—whether it resolves with fasting, its volume, and its relation to specific dietary components—can guide diagnosis.<br /><br />Practical application through case studies illustrates the clinical approach:<br />1. The management of a 55-year-old woman whose diarrhea was linked to medication (citalopram) and dietary choices. Upon changing her medication and diet, her symptoms resolved.<br />2. Another case involved gyroscopic diarrhea without significant alarm features, suggesting microscopic colitis or SIBO, managed through targeted testing and therapy.<br />3. A further case suggested empirical therapy and detailed evaluation through stool analysis or enteroscopy for potential bile acid diarrhea.<br /><br />In conclusion, a rationale approach combining a thorough history, careful examination, strategic testing, and tailored treatment leads to effective management of chronic diarrhea.

Keywords

chronic diarrhea

diagnosis

treatment

Darrell S. Pardi

quality of life

differential diagnosis

diagnostic tests

case studies

dietary influences

management strategies