Gastro 2013 APDW/WCOG Shanghai Working Party Report: Chronic diarrhea: Definition, classification, diagnosis
Gastro 2013 APDW/WCOG Shanghai Working Party Report: Chronic diarrhea: Definition, classification, diagnosis
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DOI：
10.1111/jgh.12392
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发表时间：
2014-01-01
影响因子：
4.1
通讯作者：
Sellin, Joseph H.
中科院分区：
文献类型：
--
作者：
Schiller, Lawrence R.;Pardi, Darrell S.;Sellin, Joseph H.
腹泻的最佳定义是稀便，通常伴有更频繁的排便。出于临床目的，布里斯托尔粪便形状量表可以很好地区分粪便形状和识别稀便。粪便稠度的实验室测试已经落后。急性腹泻很可能是由于感染引起的，并且是自限性的。随着腹泻变成慢性，由感染引起的可能性较小； 1 个月的持续时间似乎可以很好地作为慢性腹泻的界限，但缺乏关于该定义的实用性的详细科学知识。除了腹泻持续时间之外，根据表现情况、病理生理学和粪便特征（例如水样、脂肪性或炎症性）进行分类可能有助于精明的临床医生完善慢性腹泻的鉴别诊断。在这方面，仔细询问病史仍然是评估腹泻患者的重要部分。使用内窥镜检查和放射线照相技术对肠道进行成像是有用的，并且对小肠和结肠进行活检以进行组织学评估可提供关键的诊断信息。内窥镜检查和分子病理学目前才被探索用于慢性腹泻的诊断。人们对肠道微生物组的兴趣与日俱增；除了少数已知的病原体感染外，人们对慢性腹泻中微生物组的变化知之甚少。血清学检测在乳糜泻的诊断中具有明确的作用，但在自身免疫性肠病和炎症性肠病中的应用则不太明确。肽激素的测量对于引起腹泻的内分泌肿瘤的诊断和治疗很有价值，但这种情况非常罕见，因此这些测试在筛查方面没有什么价值，因为假阳性结果会比真阳性结果多得多。粪便的化学分析可用于对慢性腹泻进行分类，并可能限制必须考虑的鉴别诊断，但对结果的解释仍在不断发展。用于评估碳水化合物吸收不良、小肠细菌过度生长和肠道运输的呼吸测试充满了技术限制，降低了敏感性和特异性。同样，除了胆汁酸螯合剂的经验试验之外，胆汁酸吸收不良的测试的效用也有限。
Diarrhea is best defined as passage of loose stools often with more frequent bowel movements. For clinical purposes, the Bristol Stool Form Scale works well to distinguish stool form and to identify loose stools. Laboratory testing of stool consistency has lagged behind. Acute diarrhea is likely to be due to infection and to be self-limited. As diarrhea becomes chronic, it is less likely to be due to infection; duration of 1 month seems to work well as a cut-off for chronic diarrhea, but detailed scientific knowledge is missing about the utility of this definition. In addition to duration of diarrhea, classifications by presenting scenario, by pathophysiology, and by stool characteristics (e.g. watery, fatty, or inflammatory) may help the canny clinician refine the differential diagnosis of chronic diarrhea. In this regard, a careful history remains the essential part of the evaluation of a patient with diarrhea. Imaging the intestine with endoscopy and radiographic techniques is useful, and biopsy of the small intestine and colon for histological assessment provides key diagnostic information. Endomicroscopy and molecular pathology are only now being explored for the diagnosis of chronic diarrhea. Interest in the microbiome of the gut is increasing; aside from a handful of well-described infections because of pathogens, little is known about alterations in the microbiome in chronic diarrhea. Serological tests have well-defined roles in the diagnosis of celiac disease but have less clearly defined application in autoimmune enteropathies and inflammatory bowel disease. Measurement of peptide hormones is of value in the diagnosis and management of endocrine tumors causing diarrhea, but these are so rare that these tests are of little value in screening because there will be many more false-positives than true-positive results. Chemical analysis of stools is of use in classifying chronic diarrhea and may limit the differential diagnosis that must be considered, but interpretation of the results is still evolving. Breath tests for assessment of carbohydrate malabsorption, small bowel bacterial overgrowth, and intestinal transit are fraught with technical limitations that decrease sensitivity and specificity. Likewise, tests of bile acid malabsorption have had limited utility beyond empirical trials of bile acid sequestrants.