A practical approach to the patient with chronic diarrhoea
A practical approach to the patient with chronic diarrhoea
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DOI：
10.7861/clinmed.2021-0028
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发表时间：
2021-03-01
影响因子：
4.4
通讯作者：
Walters, Julian R. F.
中科院分区：
文献类型：
--
作者：
Hiner, George E.;Walters, Julian R. F.
慢性腹泻是常见的，作为几种诊断的第一表现，或作为一种长期疾病，大便频率、紧迫性和尿失禁对生活质量产生重大影响。良好的病史记录是必要的，需要考虑不同的原因：症状的开始和持续时间、以前的治疗、共存的疾病、旅行和药物使用都可能相关。检查包括血液和粪便筛查。排除炎症性肠病和结直肠肿瘤很重要，可能需要结肠镜检查。乳糜泻、显微镜下结肠炎和胆汁酸腹泻都是不应错过的常见疾病，因为每种疾病都有特定的治疗方法。伴有腹泻的功能性肠病很普遍，与其他更可治疗的疾病重叠。饮食评估和建议是有帮助的。了解高FODMAP食物，并确定个体敏感性，通常是有益的。
Chronic diarrhoea is common, occurring as the first presentation of several diagnoses, or as a prolonged disorder where stool frequency, urgency and incontinence have major impacts on quality of life. Good history taking is necessary, with different causes to be considered: onset and duration of symptoms, previous treatments, co-existing conditions, travel and drug use may all be relevant. Tests include blood and faecal screening. Exclusion of inflammatory bowel disease and colorectal neoplasia is important and may require colonoscopy. Coeliac disease, microscopic colitis and bile acid diarrhoea are all common conditions which should not be missed, as specific therapy is available for each of these. Functional bowel disorders with diarrhoea are prevalent, overlapping with other more treatable conditions. Dietetic assessment and advice are helpful. Awareness of high FODMAP foods, with identification of individual sensitivities, is often beneficial.