Diarrheal syndrome in the practice of a general practitioner: medical algorithm
DOI: 10.32364/2587-6821-2023-7-5-8
M.A. Livzan, O.V. Gaus, D.A. Gavrilenko
Omsk State Medical University, Omsk, Russian Federation
According to the frequency of seeking medical care, diarrhea is one of the most common complaints, being an important health problem. Acute diarrhea, as a rule, is infectious in nature, thus, the scope of diagnostics is aimed at assessing the patient's condition and clarifying the pathogen etiology. Chronic diarrhea has a diverse etiology, which poses a difficult task for the clinician to conduct differential diagnosis. Therefore, most guidelines on the relevant problem suggest the use of medical algorithms aimed at step-by-step exclusion of diseases accompanied by diarrhea: from the most common causes to the more rare ones. First of all, it is necessary to detail complaints, identify the presence of red flags, collect an epidemiological, drug and hereditary history, assess the nutrition habits, dietary preferences of the patient and their possible association with the manifestation of diarrhea. The general examination reveals signs of dehydration and malabsorption, as well as the presence of stigma of the underlying disease. Also, at the first stage, it is advisable to conduct the minimum necessary laboratory and instrumental studies. Subsequently, if there are difficulties in establishing the diagnosis, it is advised to re-assess the clinical picture and prescribe additional examination methods. Alongside this, symptomatic and pathogenetic therapy, dehydration, timely detection and correction of electrolyte disorders should be indicated for all patients with acute and chronic diarrhea at the stage of further examination and diagnosis confirmation.
Keywords: acute diarrhea, chronic diarrhea, diagnostic algorithm, celiac disease, intestinal tuberculosis, ischemic colitis, radiation colitis, eosinophilic colitis, microscopic colitis, Whipple disease.
For citation: Livzan M.A., Gaus O.V., Gavrilenko D.A. Diarrheal syndrome in the practice of a general practitioner: medical algorithm. Russian Medical Inquiry. 2023;7(5):300–309 (in Russ.). DOI: 10.32364/2587-6821-2023-7-5-8.
About the authors:
Maria A. Livzan — Dr. Sc. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Faculty Therapy and Gastroenterology, rector; Omsk State Medical University; 12, Lenin str., Omsk, 644099, Russian Federation; ORCID iD 0000-0002-6581-7017.
Olga V. Gaus — C. Sc. (Med.), Assistant Professor of the Department of Faculty Therapy and Gastroenterology, Omsk State Medical University; 12, Lenin str., Omsk, 644099, Russian Federation; ORCID iD 0000-0001-9370-4768.
Daria A. Gavrilenko — 6th year student of the Faculty of Medicine, Omsk State Medical University; 12, Lenin str., Omsk, 644099, Russian Federation. Contact information: Olga V. Gaus, e-mail: gaus_olga@bk.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 03.04.2023.
Revised 24.04.2023.
Accepted 22.05.2023.
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3. Парфенов А.И. Четыре варианта патогенеза и терапии диареи. Терапевтический архив. 2015;87(12):5–12. DOI: 10.17116/terarkh201587125-12. [Parfenov E.V. Four variants of the pathogenesis of diarrhea and its therapy. Terapevticheskii Arkhiv. 2015;87(12):5–12 (in Russ.)]. DOI: 10.17116/terarkh201587125-12.
4. Sokic-Milutinovic A., Pavlovic-Markovic A., Tomasevic R.S., Lukic S. Diarrhea as a Clinical Challenge: General Practitioner Approach. Dig Dis. 2022;40(3):282–289. DOI: 10.1159/000517111.
5. Keddy K.H. Old and new challenges related to global burden of diarrhoea. Lancet Infect Dis. 2018;18(11):1163–1164. DOI: 10.1016/S1473-3099(18)30424-9.
6. Arasaradnam R.P., Brown S., Forbes A. et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd ed. Gut. 2018;67(8):1380–1399. DOI: 10.1136/gutjnl-2017-315909.
7. Алексеенко С.А., Багдасарян А.А., Бакулин И.Г. и др. Краткие алгоритмы ведения пациентов на этапе оказания первичной медико-санитарной помощи. Пособие для врачей-терапевтов. Под ред. Драпкиной О.М. М.: Видокс; 2019. [Alekseyenko S.A., Bagdasaryan A.A., Bakulin I.G. et al. Brief algorithms for managing patients at the stage of providing primary health care. Handbook for physicians-therapists. Drapkinа O.M., ed. M.: Vidoks; 2019 (in Russ.)].
8. Teng C., Reveles K.R., Obodozie-Ofoegbu O.O., Frei C.R. Clostridium difficile Infection Risk with Important Antibiotic Classes: An Analysis of the FDA Adverse Event Reporting System. Int J Med Sci. 2019;16(5):630–635. DOI: 10.7150/ijms.30739.
9. Madoff R.D., Williams J.G., Caushaj P.F. Fecal incontinence. N Engl J Med. 1992;326(15):1002–1007. DOI: 10.1056/NEJM199204093261507.
10. Binder H.J. Causes of chronic diarrhea. N Engl J Med. 2006;355(3):236–239. DOI: 10.1056/NEJMp068124.
11. Lomer M.C. Review article: the aetiology, diagnosis, mechanisms and clinical evidence for food intolerance. Aliment Pharmacol Ther. 2015;41(3):262–275. DOI: 10.1111/apt.13041.
12. Гаус О.В., Ливзан М.А., Попелло Д.В. Управление питанием при синдроме раздраженного кишечника. Экспериментальная и клиническая гастроэнтерология. 2020;182(10):112–122. DOI: 10.31146/1682-8658-ecg-182-10-112-122. [Gaus O.V., Livzan M.A., Popello D.V. Power management for irritable bowel syndrome. Experimental and Clinical Gastroenterology. 2020;182(10):112–122 (in Russ.)]. DOI: 10.31146/1682-8658-ecg-182-10-112-122.
13. Chassany O., Michaux A., Bergmann J.F. Drug-induced diarrhoea. Drug Saf. 2000;22(1):53–72. DOI: 10.2165/00002018-200022010-00005.
14. Foss M.T., Clement K.D. Metformin as a cause of late-onset chronic diarrhea. Pharmacotherapy. 2001;21(11):1422–1424. DOI: 10.1592/phco.21.17.1422.34430.
15. Rogler G., Singh A., Kavanaugh A., Rubin D.T. Extraintestinal Manifestations of Inflammatory Bowel Disease: Current Concepts, Treatment, and Implications for Disease Management. Gastroenterology. 2021;161(4):1118–1132. DOI: 10.1053/j.gastro.2021.07.042.
16. Nguyen C.N., Kim S.J. Dermatitis Herpetiformis: An Update on Diagnosis, Disease Monitoring, and Management. Medicina (Kaunas). 2021;57(8):843. DOI: 10.3390/medicina57080843.
17. De Leo S., Lee S.Y., Braverman L.E. Hyperthyroidism. Lancet. 2016;388(10047):906–918. DOI: 10.1016/S0140-6736(16)00278-6.
18. Shahriari A., Papan A.M., Nazari P. How can someone's entire skin change color? Clin Case Rep. 2019;7(12):25812582. DOI: 10.1002/ccr3.2505.
19. Haque A., Hughes M. Raynaud's phenomenon. Clin Med (Lond). 2020;20(6):580–587. DOI: 10.7861/clinmed.2020-0754.
20. Olson D.E., Rhee M.K., Herrick K. et al. Screening for diabetes and pre-diabetes with proposed A1C-based diagnostic criteria. Diabetes Care. 2010;33(10):2184–2189. DOI: 10.2337/dc10-0433.
21. Fine K.D., Seidel R.H., Do K. The prevalence, anatomic distribution, and diagnosis of colonic causes of chronic diarrhea. Gastrointest Endosc. 2000;51(3):318–326. DOI: 10.1016/s0016-5107(00)70362-2.
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