Chronic diarrhea is a common problem affecting up to 5% of the population at a given time. Patients vary in their definition of diarrhea, citing loose stool consistency, increased frequency, urgency of bowel movements, or incontinence as key symptoms. Physicians have used increased frequency of defecation or increased stool weight as major criteria and distinguish acute diarrhea, often due to self-limited, acute infections, from chronic diarrhea, which has a broader differential diagnosis, by duration of symptoms; 4 weeks is a frequently used cutoff. Symptom clusters and settings can be used to assess the likelihood of particular causes of diarrhea. Irritable bowel syndrome can be distinguished from some other causes of chronic diarrhea by the presence of pain that peaks before defecation, is relieved by defecation, and is associated with changes in stool form or frequency (Rome criteria). Patients with chronic diarrhea usually need some evaluation, but history and physical examination may be sufficient to direct therapy in some. For example, diet, medications, and surgery or radiation therapy can be important causes of chronic diarrhea that can be suspected on the basis of history alone. Testing is indicated when alarm features are present, when there is no obvious cause evident, or the differential diagnosis needs further delineation. Testing of blood and stool, endoscopy, imaging studies, histology, and physiological testing all have roles to play but are not all needed in every patient. Categorizing patients after limited testing may allow more directed testing and more rapid diagnosis. Empiric antidiarrheal therapy can be used to mitigate symptoms in most patients for whom a specific treatment is not available.

译文

慢性腹泻是一个常见问题,在特定时间影响多达5%的人口。病人以腹泻的定义不同,以大便不均匀,频率增加,排便紧迫或失禁为主要症状。医师以增加排便次数或增加粪便重量为主要标准,并根据症状持续时间将急性腹泻与慢性腹泻区分开来,而急性腹泻通常是由于自限性急性感染引起的,而慢性腹泻的诊断范围更广。 4周是一个常用的截止时间。症状群集和设置可用于评估特定原因引起的腹泻的可能性。肠易激综合征可以通过在排便前达到峰值,通过排便缓解,并与大便形式或频率变化相关的疼痛而与慢性腹泻的其他原因区分开。慢性腹泻患者通常需要一些评估,但病史和体格检查可能足以指导某些患者的治疗。例如,饮食,药物,外科手术或放射疗法可能是导致慢性腹泻的重要原因,仅根据病史就可以怀疑。当存在警报功能时,没有明显原因可言或需要进一步描述差异诊断时,将指示测试。血液和粪便的检测,内窥镜检查,影像学检查,组织学和生理学检测都可以发挥作用,但并不是每个患者都需要这些检测。在有限的测试后对患者进行分类可以允许进行更直接的测试和更快速的诊断。经验丰富的腹泻疗法可用于缓解大多数无法获得特定治疗的患者的症状。

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