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Mistakes in the management of unexplained diarrhoea and how to avoid them

Magnus Simrén, Hans Törnblom

Summary

AI Generated

This material discusses basic mistakes to avoid when managing unexplained non-bloody diarrhoea that persists beyond the acute setting in patients without alarm features.

  • Diarrhoea becomes chronic when it persists for a month or more since onset.
  • Acute diarrhoea in healthy individuals is often self-limiting due to short-lived reactions to food intake or bacterial and viral infections.
  • Most acute diarrhoea cases require limited diagnostic efforts except fluid electrolyte replacement and stool culture in severe occurrences.
  • The content uses an evidence-based approach supplemented by clinical experience and focuses on patients where initial consultations have not yielded a diagnosis.
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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
Stotzer, P.O., 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(4): p. 381-6. [Link]
2.
Lewis, S.J. and K.W. Heaton, Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol, 1997. 32(9): p. 920-4. [Link]
3.
Drossman, D.A., et al., Rome IV multidimensional clinical profile for the functional gastrointestinal disorders. 2nd ed. Raleigh, NC: The Rome Foundation. 2016. [Link]
4.
Drossman, D.A., 2012 David Sun lecture: helping your patient by helping yourself--how to improve the patient-physician relationship by optimizing communication skills. Am J Gastroenterol, 2013. 108(4): p. 521-8. [Link]
5.
Drossman, D.A. and W.G. Thompson, The irritable bowel syndrome: review and a graduated multicomponent treatment approach. Ann Intern Med, 1992. 116(12 Pt 1): p. 1009-16. [Link]
6.
Owens, D.M., D.K. Nelson, and N.J. Talley, The irritable bowel syndrome: long-term prognosis and the physician-patient interaction. Ann Intern Med, 1995. 122(2): p. 107-12. [Link]
7.
Drossman, D.A. and W.L. Hasler, Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology, 2016. 150(6): p. 1257-61. [Link]
8.
Sperber, A.D., et al., Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology, 2021. 160(1): p. 99-114 e3. [Link]
9.
Lacy, B.E., et al., Bowel Disorders. Gastroenterology, 2016. 150: p. 1393-1407. [Link]
10.
Camilleri, M. and S. Nurko, Bile Acid Diarrhea in Adults and Adolescents. Neurogastroenterol Motil, 2022. 34(4): p. e14287. [Link]
11.
Miehlke, S., et al., Microscopic colitis: pathophysiology and clinical management. Lancet Gastroenterol Hepatol, 2019. 4(4): p. 305-314. [Link]
12.
Vasant, D.H., et al., British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut, 2021. 70(7): p. 1214-1240. [Link]
13.
Begtrup, L.M., et al., A positive diagnostic strategy is noninferior to a strategy of exclusion for patients with irritable bowel syndrome. Clin Gastroenterol Hepatol, 2013. 11(8): p. 956-62 e1. [Link]
14.
Engsbro, A.L., et al., A positive diagnostic strategy is safe and saves endoscopies in patients with irritable bowel syndrome: A five-year follow-up of a randomized controlled trial. Neurogastroenterol Motil, 2020: p. e14004. [Link]
15.
Staller, K., et al., Mortality Risk in Irritable Bowel Syndrome: Results From a Nationwide Prospective Cohort Study. Am J Gastroenterol, 2020. [Link]
16.
Staller, K., et al., Diagnostic yield of endoscopy in irritable bowel syndrome: A nationwide prevalence study 1987-2016. Eur J Intern Med, 2021. [Link]
17.
McNeil CJ, Kirkcaldy RD, Workowski K. Enteric Infections in Men Who Have Sex With Men. Clin Infect Dis. 2022;74(Suppl_2):S169-S178. [Link]
18.
Barbara, G., et al., Rome Foundation Working Team Report on Post-Infection Irritable Bowel Syndrome. Gastroenterology, 2019. 156(1): p. 46-58 e7. [Link]
19.
Smalley, W., et al., AGA Clinical Practice Guidelines on the Laboratory Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome in Adults (IBS-D). Gastroenterology, 2019. 157(3): p. 851-854. [Link]
20.
Marth, T., et al., Tropheryma whipplei infection and Whipple's disease. Lancet Infect Dis, 2016. 16(3): p. e13-22. [Link]
21.
Quigley, E.M.M., J.A. Murray, and M. Pimentel, AGA Clinical Practice Update on Small Intestinal Bacterial Overgrowth: Expert Review. Gastroenterology, 2020. 159(4): p. 1526-1532. [Link]
22.
Misselwitz, B., et al., Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut, 2019. 68(11): p. 2080-2091. [Link]
23.
Collin, P., et al., Review article: coeliac disease in later life must not be missed. Aliment Pharmacol Ther, 2018. 47(5): p. 563-572. [Link]
24.
Rao, K. and P.N. Malani, Diagnosis and Treatment of Clostridioides (Clostridium) difficile Infection in Adults in 2020. JAMA, 2020. 323(14): p. 1403-1404. [Link]
25.
Garsed, K., et al., A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea. Gut, 2014. 63(10): p. 1617-25. [Link]
26.
Richard, N., et al., The effectiveness of rotating versus single course antibiotics for small intestinal bacterial overgrowth. United European Gastroenterol J, 2021. 9(6): p. 645-654. [Link]
27.
Rej, A., et al., The role of diet in irritable bowel syndrome: implications for dietary advice. J Intern Med, 2019. 286(5): p. 490-502. [Link]
28.
Black, C.J., H.M. Staudacher, and A.C. Ford, Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut, 2021. [Link]

Abstract

Diarrhoea, acute or chronic, is a common gastrointestinal symptom in healthcare. In most cases, acute diarrhoea in healthy individuals requires limited diagnostic and therapeutic efforts, except for the replacement of fluid electrolytes, and stool culture in severe occurrences. Acute diarrhoea is often self-limiting due to short-lived reactions to food intake and bacterial or viral infections. However, diarrhoea can persist and fulfil definitions of chronicity when a month or more has passed since the onset. Here we discuss some basic mistakes that should be avoided when managing unexplained non-bloody diarrhoea that persists beyond the acute setting. In this context, the term 'unexplained' refers to a patient without apparent alarm features and where initial consultations have failed at making a diagnosis. We used an evidence-based approach and included aspects predominantly based on clinical experience when appropriate.


Topics

Neurogastroenterology & Motility

Citation

Törnblom H and Simrén M. Mistakes in the management of unexplained diarrhoea and how to avoid them. UEG Education 2022; 22: 16–19.

Published

2022

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Summary

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Hepatobiliary

Published

2026

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

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Mistakes in Familial Mediterranean Fever and how to avoid them

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Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
Stotzer, P.O., 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(4): p. 381-6. [Link]
2.
Lewis, S.J. and K.W. Heaton, Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol, 1997. 32(9): p. 920-4. [Link]
3.
Drossman, D.A., et al., Rome IV multidimensional clinical profile for the functional gastrointestinal disorders. 2nd ed. Raleigh, NC: The Rome Foundation. 2016. [Link]
4.
Drossman, D.A., 2012 David Sun lecture: helping your patient by helping yourself--how to improve the patient-physician relationship by optimizing communication skills. Am J Gastroenterol, 2013. 108(4): p. 521-8. [Link]
5.
Drossman, D.A. and W.G. Thompson, The irritable bowel syndrome: review and a graduated multicomponent treatment approach. Ann Intern Med, 1992. 116(12 Pt 1): p. 1009-16. [Link]
6.
Owens, D.M., D.K. Nelson, and N.J. Talley, The irritable bowel syndrome: long-term prognosis and the physician-patient interaction. Ann Intern Med, 1995. 122(2): p. 107-12. [Link]
7.
Drossman, D.A. and W.L. Hasler, Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology, 2016. 150(6): p. 1257-61. [Link]
8.
Sperber, A.D., et al., Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology, 2021. 160(1): p. 99-114 e3. [Link]
9.
Lacy, B.E., et al., Bowel Disorders. Gastroenterology, 2016. 150: p. 1393-1407. [Link]
10.
Camilleri, M. and S. Nurko, Bile Acid Diarrhea in Adults and Adolescents. Neurogastroenterol Motil, 2022. 34(4): p. e14287. [Link]
11.
Miehlke, S., et al., Microscopic colitis: pathophysiology and clinical management. Lancet Gastroenterol Hepatol, 2019. 4(4): p. 305-314. [Link]
12.
Vasant, D.H., et al., British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut, 2021. 70(7): p. 1214-1240. [Link]
13.
Begtrup, L.M., et al., A positive diagnostic strategy is noninferior to a strategy of exclusion for patients with irritable bowel syndrome. Clin Gastroenterol Hepatol, 2013. 11(8): p. 956-62 e1. [Link]
14.
Engsbro, A.L., et al., A positive diagnostic strategy is safe and saves endoscopies in patients with irritable bowel syndrome: A five-year follow-up of a randomized controlled trial. Neurogastroenterol Motil, 2020: p. e14004. [Link]
15.
Staller, K., et al., Mortality Risk in Irritable Bowel Syndrome: Results From a Nationwide Prospective Cohort Study. Am J Gastroenterol, 2020. [Link]
16.
Staller, K., et al., Diagnostic yield of endoscopy in irritable bowel syndrome: A nationwide prevalence study 1987-2016. Eur J Intern Med, 2021. [Link]
17.
McNeil CJ, Kirkcaldy RD, Workowski K. Enteric Infections in Men Who Have Sex With Men. Clin Infect Dis. 2022;74(Suppl_2):S169-S178. [Link]
18.
Barbara, G., et al., Rome Foundation Working Team Report on Post-Infection Irritable Bowel Syndrome. Gastroenterology, 2019. 156(1): p. 46-58 e7. [Link]
19.
Smalley, W., et al., AGA Clinical Practice Guidelines on the Laboratory Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome in Adults (IBS-D). Gastroenterology, 2019. 157(3): p. 851-854. [Link]
20.
Marth, T., et al., Tropheryma whipplei infection and Whipple's disease. Lancet Infect Dis, 2016. 16(3): p. e13-22. [Link]
21.
Quigley, E.M.M., J.A. Murray, and M. Pimentel, AGA Clinical Practice Update on Small Intestinal Bacterial Overgrowth: Expert Review. Gastroenterology, 2020. 159(4): p. 1526-1532. [Link]
22.
Misselwitz, B., et al., Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut, 2019. 68(11): p. 2080-2091. [Link]
23.
Collin, P., et al., Review article: coeliac disease in later life must not be missed. Aliment Pharmacol Ther, 2018. 47(5): p. 563-572. [Link]
24.
Rao, K. and P.N. Malani, Diagnosis and Treatment of Clostridioides (Clostridium) difficile Infection in Adults in 2020. JAMA, 2020. 323(14): p. 1403-1404. [Link]
25.
Garsed, K., et al., A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea. Gut, 2014. 63(10): p. 1617-25. [Link]
26.
Richard, N., et al., The effectiveness of rotating versus single course antibiotics for small intestinal bacterial overgrowth. United European Gastroenterol J, 2021. 9(6): p. 645-654. [Link]
27.
Rej, A., et al., The role of diet in irritable bowel syndrome: implications for dietary advice. J Intern Med, 2019. 286(5): p. 490-502. [Link]
28.
Black, C.J., H.M. Staudacher, and A.C. Ford, Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut, 2021. [Link]

Abstract

Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.1 Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.2 Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.3

Topics

Primary Care

Published

2025

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Summary

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

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Digestive Oncology Endoscopy Oesophagus

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Abstract

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Abstract

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Episode 1: UEG Journal May spotlight

Mohsan Subhani, Maria Manuela Estevinho

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

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