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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Abstract

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Small Intestine & Nutrition

Published

2026

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Summary

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Summary is not available for this content yet.

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Abstract

Topics

Stomach & H. Pylori

Published

2025

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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, 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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Pradeep Mundre

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

Sarah Townsend

Mistakes in the use of PPIs and how to avoid them

Albert J. Bredenoord

Mistakes in Familial Mediterranean Fever and how to avoid them

Gagik Hakobyan

MASLD with Sven Francque - Part 2

Pradeep Mundre

UEG Mistakes In Articles

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

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Mistakes in Familial Mediterranean Fever and how to avoid them

Manik Gemilyan, Gagik Hakobyan

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

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

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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Mistakes in the use of PPIs and how to avoid them

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Mistakes in Familial Mediterranean Fever and how to avoid them

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UEG Podcast Episode

UEG Podcast

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

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

MASLD with Sven Francque - Part 2

Sven Francque, Pradeep Mundre

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Topics

Hepatobiliary

Published

2026

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