Mistakes in chronic diarrhoea and how to avoid them

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Mistakes in chronic diarrhoea and how to avoid them

Julian Roger Ford Walters

Summary

AI Generated

Chronic diarrhoea, defined as lasting more than 3 or 4 weeks, is a common condition affecting an estimated 5% of the population who seek medical advice, with many patients receiving diagnoses of IBS-D or functional diarrhoea after exclusion of serious conditions.

Most people presenting with chronic diarrhoea will not have inflammatory bowel disease or colorectal cancer.
If less common disorders are not considered, patients may be given a diagnosis of diarrhoea-predominant irritable bowel syndrome (IBS-D) or functional diarrhoea.
Many different treatments are used for IBS-D but often benefit only a small proportion of patients, leaving many with unmet needs seeking further investigation, advice and treatment.
Gastroenterologists commonly encounter patients whose principal complaint is frequent, loose stools requiring investigation to exclude serious conditions.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Lacy BE, et al. Bowel Disorders. Gastroenterology 2016; 150: 1393–1407.e5. [Link]

Arasaradnam RP, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut 2018; 67: 1380–1399. [Link]

Stotzer PO, et al. Are the definitions for chronic diarrhoea adequate? Evaluation of two different definitions in patients with chronic diarrhoea. United European Gastroenterol J 2015; 3: 381–386. [Link]

Fuchs V, et al. Factors associated with long diagnostic delay in celiac disease. Scand J Gastroenterol 2014; 49: 1304–1310. [Link]

Bannaga A, et al. How bad is bile acid diarrhoea: an online survey of patient–reported symptoms and outcomes. BMJ Open Gastroenterol 2017; 4: e000116. [Link]

Valentin N, et al. Biomarkers for bile acid diarrhoea in functional bowel disorder with diarrhoea: a systematic review and meta–analysis. Gut 2016; 65: 1951–1959. [Link]

Guagnozzi D, et al. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43: 851–862. [Link]

Patel SG and Ahnen DJ. Colorectal cancer in the Young. Curr Gastroenterol Rep 2018; 20: 15. [Link]

Wedlake L, et al. Systematic review: the prevalence of idiopathic bile acid malabsorption (I-BAM) as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome (IBS). Aliment Pharmacol Ther 2009; 30: 707–717. [Link]

10.

Turner JM, et al. A positive SeHCAT test results in fewer subsequent investigations in patients with chronic diarrhoea. Frontline Gastroenterol 2017; 8: 279–283. [Link]

11.

Fernandes DCR, et al. What is the cost of delayed diagnosis of bile acid malabsorption and bile acid diarrhoea? Frontline Gastroenterology 2019; 10: 72–76. [Link]

12.

Vijayvargiya P, et al. Performance characteristics of serum C4 and FGF19 measurements to exclude the diagnosis of bile acid diarrhoea in IBS-diarrhoea and functional diarrhoea. Aliment Pharmacol Ther 2017; 46: 581–588. [Link]

13.

Vijayvargiya P, et al. Analysis of fecal primary bile acids detects increased stool weight and colonic transit in patients with chronic functional diarrhea. Clin Gastroenterol Hepatol Epub ahead of print 11 June 2018. DOI: 10.1016/j.cgh.2018.05.050. [Link]

14.

Pardi DS, et al. American Gastroenterological Association Institute technical review on the medical management of microscopic colitis. Gastroenterology 2016; 150: 247–274. [Link]

15.

Rangan V, et al. Risk factors for fecal urgency among individuals with and without diarrhea, based on data from the National Health and Nutrition Examination Survey. Clin Gastroenterol Hepatol 2018; 16: 1450–1458. [Link]

16.

Carrington EV, et al. Expert consensus document: Advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol 2018; 15: 309–323. [Link]

17.

Staudacher HM and Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut 2017; 66: 1517–1527. [Link]

18.

De Georgio R, et al. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction? Gut 2016; 65: 169–178. [Link]

19.

Watson L, et al. Management of bile acid malabsorption using low-fat dietary interventions: a useful strategy applicable to some patients with diarrhoea-predominant irritable bowel syndrome? Clin Med (Lond) 2015; 15: 536–540. [Link]

20.

Munch A, et al. Low-dose budesonide for maintenance of clinical remission in collagenous colitis: a randomised, placebo-controlled, 12-month trial. Gut 2016; 65: 47–56. [Link]

Abstract

Chronic diarrhoea, lasting more than 3 or 4 weeks, is a common condition with a wide variety of different possible causes. Estimates suggest 5% of the population have experienced chronic diarrhoea and sought medical advice about it. All gastroenterologists see many patients whose principal complaint is frequent, loose stools, and will be aware of investigations that are needed to diagnose serious conditions such as inflammatory bowel disease (IBD) or colorectal cancer (CRC). Most people who present with chronic diarrhoea will not have these conditions and, if less common disorders are not considered, may be given a diagnosis of diarrhoea-predominant irritable bowel syndrome (IBS-D) or perhaps functional diarrhoea. Many different treatments are used for IBS-D and often benefit only a small proportion of patients, leaving many with unmet needs, seeking further investigation, advice and treatment.

Topics

Neurogastroenterology & Motility

Citation

Walters JRF. Mistakes in chronic diarrhoea and how to avoid them. UEG Education 2019; 19: 1–4.

Published

2019

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UEG Podcast Episode

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Abstract

Topics

Small Intestine & Nutrition

Published

2026

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Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Lacy BE, et al. Bowel Disorders. Gastroenterology 2016; 150: 1393–1407.e5. [Link]

Arasaradnam RP, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut 2018; 67: 1380–1399. [Link]

Fuchs V, et al. Factors associated with long diagnostic delay in celiac disease. Scand J Gastroenterol 2014; 49: 1304–1310. [Link]

Bannaga A, et al. How bad is bile acid diarrhoea: an online survey of patient–reported symptoms and outcomes. BMJ Open Gastroenterol 2017; 4: e000116. [Link]

Valentin N, et al. Biomarkers for bile acid diarrhoea in functional bowel disorder with diarrhoea: a systematic review and meta–analysis. Gut 2016; 65: 1951–1959. [Link]

Guagnozzi D, et al. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43: 851–862. [Link]

Patel SG and Ahnen DJ. Colorectal cancer in the Young. Curr Gastroenterol Rep 2018; 20: 15. [Link]

10.

Turner JM, et al. A positive SeHCAT test results in fewer subsequent investigations in patients with chronic diarrhoea. Frontline Gastroenterol 2017; 8: 279–283. [Link]

11.

Fernandes DCR, et al. What is the cost of delayed diagnosis of bile acid malabsorption and bile acid diarrhoea? Frontline Gastroenterology 2019; 10: 72–76. [Link]

12.

13.

14.

Pardi DS, et al. American Gastroenterological Association Institute technical review on the medical management of microscopic colitis. Gastroenterology 2016; 150: 247–274. [Link]

15.

16.

Carrington EV, et al. Expert consensus document: Advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol 2018; 15: 309–323. [Link]

17.

Staudacher HM and Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut 2017; 66: 1517–1527. [Link]

18.

De Georgio R, et al. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction? Gut 2016; 65: 169–178. [Link]

19.

20.

Munch A, et al. Low-dose budesonide for maintenance of clinical remission in collagenous colitis: a randomised, placebo-controlled, 12-month trial. Gut 2016; 65: 47–56. [Link]

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

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UEG Mistakes In Articles

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Mistakes in metabolic dysfunction associated steatotic liver disease and how to avoid them

Sarah Townsend, Philip Newsome

Summary

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Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Lacy BE, et al. Bowel Disorders. Gastroenterology 2016; 150: 1393–1407.e5. [Link]

Arasaradnam RP, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut 2018; 67: 1380–1399. [Link]

Fuchs V, et al. Factors associated with long diagnostic delay in celiac disease. Scand J Gastroenterol 2014; 49: 1304–1310. [Link]

Bannaga A, et al. How bad is bile acid diarrhoea: an online survey of patient–reported symptoms and outcomes. BMJ Open Gastroenterol 2017; 4: e000116. [Link]

Valentin N, et al. Biomarkers for bile acid diarrhoea in functional bowel disorder with diarrhoea: a systematic review and meta–analysis. Gut 2016; 65: 1951–1959. [Link]

Guagnozzi D, et al. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43: 851–862. [Link]

Patel SG and Ahnen DJ. Colorectal cancer in the Young. Curr Gastroenterol Rep 2018; 20: 15. [Link]

10.

Turner JM, et al. A positive SeHCAT test results in fewer subsequent investigations in patients with chronic diarrhoea. Frontline Gastroenterol 2017; 8: 279–283. [Link]

11.

Fernandes DCR, et al. What is the cost of delayed diagnosis of bile acid malabsorption and bile acid diarrhoea? Frontline Gastroenterology 2019; 10: 72–76. [Link]

12.

13.

14.

Pardi DS, et al. American Gastroenterological Association Institute technical review on the medical management of microscopic colitis. Gastroenterology 2016; 150: 247–274. [Link]

15.

16.

Carrington EV, et al. Expert consensus document: Advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol 2018; 15: 309–323. [Link]

17.

Staudacher HM and Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut 2017; 66: 1517–1527. [Link]

18.

De Georgio R, et al. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction? Gut 2016; 65: 169–178. [Link]

19.

20.

Munch A, et al. Low-dose budesonide for maintenance of clinical remission in collagenous colitis: a randomised, placebo-controlled, 12-month trial. Gut 2016; 65: 47–56. [Link]

Abstract

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a subclassification of steatotic liver disease (SLD), defined as the presence of excess triglyceride storage in the liver in conjunction with at least one cardiometabolic risk factor and no other discernible cause.1 Cirrhosis secondary to MASH is the most common cause of liver disease in the world and is the fastest-growing indication for liver transplantation, but it also has a >50% recurrence rate post-transplantation.

Topics

Hepatobiliary

Citation

Townsend SA and Newsome PN. Mistakes in nonalcoholic fatty liver disease and how to avoid them. UEG Education 2017; 17: 39–41.

Published

2024

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Mistakes in the use of PPIs and how to avoid them

Albert J. Bredenoord

Correct use of telemedicine in gastroenterology, hepatology, and endoscopy during and after the COVID-19 pandemic: Recommendations from the Italian association of hospital gastroenterologists and endoscopists (AIGO)

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Patrizia Burra

UEG Mistakes In Articles

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Mistakes in the use of PPIs and how to avoid them

Albert J. Bredenoord, Roos E. Pouw

Summary

AI Generated

Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Lacy BE, et al. Bowel Disorders. Gastroenterology 2016; 150: 1393–1407.e5. [Link]

Arasaradnam RP, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut 2018; 67: 1380–1399. [Link]

Fuchs V, et al. Factors associated with long diagnostic delay in celiac disease. Scand J Gastroenterol 2014; 49: 1304–1310. [Link]

Bannaga A, et al. How bad is bile acid diarrhoea: an online survey of patient–reported symptoms and outcomes. BMJ Open Gastroenterol 2017; 4: e000116. [Link]

Valentin N, et al. Biomarkers for bile acid diarrhoea in functional bowel disorder with diarrhoea: a systematic review and meta–analysis. Gut 2016; 65: 1951–1959. [Link]

Guagnozzi D, et al. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43: 851–862. [Link]

Patel SG and Ahnen DJ. Colorectal cancer in the Young. Curr Gastroenterol Rep 2018; 20: 15. [Link]

10.

Turner JM, et al. A positive SeHCAT test results in fewer subsequent investigations in patients with chronic diarrhoea. Frontline Gastroenterol 2017; 8: 279–283. [Link]

11.

Fernandes DCR, et al. What is the cost of delayed diagnosis of bile acid malabsorption and bile acid diarrhoea? Frontline Gastroenterology 2019; 10: 72–76. [Link]

12.

13.

14.

Pardi DS, et al. American Gastroenterological Association Institute technical review on the medical management of microscopic colitis. Gastroenterology 2016; 150: 247–274. [Link]

15.

16.

Carrington EV, et al. Expert consensus document: Advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol 2018; 15: 309–323. [Link]

17.

Staudacher HM and Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut 2017; 66: 1517–1527. [Link]

18.

De Georgio R, et al. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction? Gut 2016; 65: 169–178. [Link]

19.

20.

Munch A, et al. Low-dose budesonide for maintenance of clinical remission in collagenous colitis: a randomised, placebo-controlled, 12-month trial. Gut 2016; 65: 47–56. [Link]

Abstract

Proton pump inhibitors (PPIs), first introduced with omeprazole in 1988, revolutionized the treatment of gastric acid-related conditions like gastro-oesophageal reflux disease, gastroduodenal ulcers, and Helicobacter pylori infections. Despite their effectiveness, PPIs are often prescribed for conditions without a proven link to gastric acid, such as dyspepsia and upper abdominal discomfort. Long-term use of PPIs has raised safety concerns, including risks of vitamin and mineral malabsorption, pneumonia, gastrointestinal infections, and dementia. This Mistakes In article addresses nine common mistakes in PPI use and aims to clarify misconceptions about their use.

Topics

Digestive Oncology Oesophagus

Citation

Pouw R.E. and Bredenoord A.J. Mistakes in the use of PPIs and how to avoid them. UEG Education 2017; 17: 15–17.

Published

2024

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Mistakes in the use of PPIs and how to avoid them

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UEG Standards and Guidelines

Position Paper

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Correct use of telemedicine in gastroenterology, hepatology, and endoscopy during and after the COVID-19 pandemic: Recommendations from the Italian association of hospital gastroenterologists and endoscopists (AIGO)

Andrea Costantino

Summary

AI Generated

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Guideline

Abstract

The purpose of the present document is to provide detailed information on the correct and optimal use of digital media to ensure continuity of care for gastroenterological patients in everyday clinical practice, in health emergencies and/or when the patient cannot reach the hospital for other reasons.

During the recent COVID-19 pandemic, telemedicine has allowed many patients with chronic diseases to access remote care worldwide, proving to be the ideal solution to overcome restrictions and carry out non-urgent routine follow-ups on chronic patients. The COVID-19 pandemic has therefore made organizational and cultural renewal essential for the reorganization of healthcare in order to ensure greater continuity of care with a minimum risk of spreading the virus to users, practitioners and their families.

These AIGO recommendations are intended to provide Italian gastroenterologists with a tool to use this method appropriately, in compliance with current legislation, in particular the proper approach and procedures for conducting a remote examination using a video conferencing tool, the so-called televisit.

In the near future, telemedicine may contribute to a possible reorganization of healthcare systems, through innovative care models focusing on the citizen and facilitating access to services throughout the entire Country.

Keywords: Telemedicine; Telehealth; Inflammatory bowel diseases; Celiac disease; Hepatology; Endoscopy

Guideline

Position Paper

Topics

Endoscopy Hepatobiliary IBD Primary Care Small Intestine & Nutrition Stomach & H. Pylori

Citation

Digestive and Liver Disease VOLUME 53, ISSUE 10, P1221-1227

Published

2021

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Correct use of telemedicine in gastroenterology, hepatology, and endoscopy during and after the COVID-19 pandemic: Recommendations from the Italian association of hospital gastroenterologists and endoscopists (AIGO)

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UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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Mistakes in transitional care for children and young adults and how to avoid them

Patrizia Burra, Hans Törnblom, Jorge Amil Dias, Moriam Mustapha

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Lacy BE, et al. Bowel Disorders. Gastroenterology 2016; 150: 1393–1407.e5. [Link]

Arasaradnam RP, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut 2018; 67: 1380–1399. [Link]

Fuchs V, et al. Factors associated with long diagnostic delay in celiac disease. Scand J Gastroenterol 2014; 49: 1304–1310. [Link]

Bannaga A, et al. How bad is bile acid diarrhoea: an online survey of patient–reported symptoms and outcomes. BMJ Open Gastroenterol 2017; 4: e000116. [Link]

Valentin N, et al. Biomarkers for bile acid diarrhoea in functional bowel disorder with diarrhoea: a systematic review and meta–analysis. Gut 2016; 65: 1951–1959. [Link]

Guagnozzi D, et al. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43: 851–862. [Link]

Patel SG and Ahnen DJ. Colorectal cancer in the Young. Curr Gastroenterol Rep 2018; 20: 15. [Link]

10.

Turner JM, et al. A positive SeHCAT test results in fewer subsequent investigations in patients with chronic diarrhoea. Frontline Gastroenterol 2017; 8: 279–283. [Link]

11.

Fernandes DCR, et al. What is the cost of delayed diagnosis of bile acid malabsorption and bile acid diarrhoea? Frontline Gastroenterology 2019; 10: 72–76. [Link]

12.

13.

14.

Pardi DS, et al. American Gastroenterological Association Institute technical review on the medical management of microscopic colitis. Gastroenterology 2016; 150: 247–274. [Link]

15.

16.

Carrington EV, et al. Expert consensus document: Advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol 2018; 15: 309–323. [Link]

17.

Staudacher HM and Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut 2017; 66: 1517–1527. [Link]

18.

De Georgio R, et al. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction? Gut 2016; 65: 169–178. [Link]

19.

20.

Munch A, et al. Low-dose budesonide for maintenance of clinical remission in collagenous colitis: a randomised, placebo-controlled, 12-month trial. Gut 2016; 65: 47–56. [Link]

Abstract

Children and adolescents with chronic diseases requiring lifelong care face unique challenges that affect their daily lives and those of their families. Initially, these patients receive specialized care in pediatric facilities, where parents play a key role in treatment decisions. However, transitioning to adult healthcare facilities is inevitable, and this process, recognized as crucial years ago, involves moving adolescents with chronic conditions from child-centered to adult-oriented care. This transition can be complicated by varying age limits for pediatric care and the scarcity of adult care centers with specific expertise. The transition often requires cooperation between different centers or even countries due to patient mobility. The transition phase is critical, as it can lead to loss of follow-up, treatment suspension, and increased risks of complications or disease relapse. Beyond medical management, various factors influence the long-term prognosis of chronic conditions, making a well-organized transition program essential. While many hospitals have implemented transition models with mixed results in satisfaction, disease control, and follow-up adherence, there are frequent shortcomings in the process. This Mistakes In article will outline eight common mistakes made during the transition from pediatric to adult care, supported by literature and professional experience.

Topics

Primary Care

Citation

Jorge Amil-Dias, Hans Törnblom, Moriam Mustapha and Patrizia Burra. Mistakes in transitional care for children and young adults and how to avoid them. UEG Education 2023; 23: 22-25.

Published

2023

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Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino

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Mistakes in the use of PPIs and how to avoid them

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Correct use of telemedicine in gastroenterology, hepatology, and endoscopy during and after the COVID-19 pandemic: Recommendations from the Italian association of hospital gastroenterologists and endoscopists (AIGO)

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Mistakes in transitional care for children and young adults and how to avoid them

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