Pathophysiological approach to chronic diarrhoea
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SELECTED PAPER – CHRONIC DIARRHOEA
Pathophysiological approach to chronic diarrhoea Enrico Stefano Corazziari
Ó SIMI 2012
Abstract Chronic diarrhoea disrupts everyday life because of urgency, incontinence and frequent bowel movements. Non-inflammatory diarrhoea may be secondary to altered process of absorption, secretion or digestion. The most prevalent functional diarrhoea is due to altered gut–brain interaction and often after an acute gastroenteritis. Microscopic colitis, rare cases of eosinophilic colitis, congenital diarrhoeal disorders and bile acid malabsorption have been more frequently reported and their pathophysiology elucidated. Keywords
Diarrhoea Chronic Pathophysiology
Introduction Chronic diarrhoea can be classified as being due to osmotic, secretory, inflammatory and motor mechanisms. Non-inflammatory diarrhoea may be secondary to altered process of absorption, secretion or digestion as may occur in celiac disease, pancreatic insufficiency, and endocrine diseases. The text of this chapter will not attempt to cover the mechanisms of the entire spectrum of chronic diarrhoeas and of those with a well consolidated knowledge of pathophysiology. It will be mainly focused on the basic pathophysiologic aspects of diarrhoeal clinical manifestations and individual diarrhoea-derived behaviour, and to some chronic diarrhoeas the pathogenesis of which has either been recently unveiled or not yet fully clarified.
Clinical expression of chronic diarrhoea Sensation of loose stool, urgency, incontinence, frequent bowel movements, and disruption of everyday life are the most frequent manifestations reported by patients with chronic diarrhoea. Stool consistency, urgency and incontinence The sensation of loose stools is an important symptom of diarrhoea for many patients and originates in the sensitive anal receptors. Stool viscosity is determined by stool water content, and small variations of water content from the normal range of 70–75 % [1] to 78–79 % in those with functional diarrhoea [2, 3] result in a marked decrease in stool viscosity. This depends on free water content and the water-holding capacity of faecal insoluble solids. Dietary fibres can hold an average of 70 % of water [4–7]. Patients who have control of solid stool may be incontinent to watery stool or refer to severe urgency [8, 9]. Thus, stool consistency is an important factor in urgency and continence. Urgency is the compelling stimulus to defecate once the rectum has detected the presence of stool. For many patients, this is the most bothersome symptom and the fear of losing continence dominates their everyday life [10]. In patients with diarrhoea, incontinence was reported by 20 % in those who had consulted a doctor.
Quality of life E. S. Corazziari (&) Dipartimento di Medicina Interna e Specialita` Mediche, UOC Gastroenterologia A Universita` Sapienza, Rome, Italy e-mail: [email protected]
Disruption of daily activities is a frequent consequence of diarrhoeal symptoms. Work, eating, sleeping, sexual activities, and social
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