Assessment of chronic diarrhoea

Overview 
Theory 
Emergencies 
Diagnosis 
Resources 

Common

Ulcerative colitis

History

haematochezia and tenesmus usually significant; diarrhoea may be frequent but low volume; recent cessation of tobacco use associated with the onset of active ulcerative colitis; may be a family history[10][11][12][13]

Exam

generally non-specific; extraintestinal manifestations, such as erythema nodosum, pyoderma gangrenosum, uveitis, iritis, episcleritis, and arthritis

1st investigation

endoscopy/colonoscopy with biopsy:
mucosal lesions consistent with colitis and/or enteritis[10]
More
In the absence of granulomas, found in 30% of cases of Crohn's disease, the differentiation between ulcerative colitis and Crohn's disease is made primarily on clinical grounds and presence of lesions outside the colon.
If diagnosis of Crohn's disease still needs to be excluded after colonoscopy, further small bowel investigations (contrast study/CT/MRI/capsule endoscopy) may show stricture lesions in the small bowel.

Other investigations

abdominal radiograph:
transverse colon ≥6 cm in diameter in toxic megacolon
More
faecal calprotectin:
elevated
More
Has been shown to consistently differentiate inflammatory bowel disease from irritable bowel syndrome.[4][7][8] However, faecal calprotectin can also be elevated in some cases of colorectal cancer, gastrointestinal infection, or with use of non-steroidal anti-inflammatory drugs.[4]

Ulcerative colitis

Microscopic colitis (lymphocytic colitis and collagenous colitis)

History

presence of coeliac disease raises concern for lymphocytic colitis; diarrhoea frequent and voluminous, may be associated with mild degrees of abdominal pain, weight loss, and fatigue[14][15][16][17][18][19][20][21][22]

Exam

generally non-specific

1st investigation

colonoscopy with colonic biopsies:
collagenous colitis: thickened subepithelial collagenous band >7 micrometre; lymphocytic colitis: prominent subepithelial lymphocytic infiltrate
More

Other investigations

IgA-tissue transglutaminase (tTg):
elevated, if coeliac disease also present (check local reference values)
oesophagogastroduodenoscopy with duodenal biopsies:
increased intraepithelial lymphocytes, villous atrophy, and crypt hyperplasia, if coeliac disease also present

Microscopic colitis

Viral, bacterial, parasitic, HIV enteropathy

History

onset likely to be acute; may be history of travel, sick contacts, or immunosuppression[23][24][25][26][27][28][29][30][31]

Exam

usually non-specific; specific infections may have systemic manifestations (e.g., rash in typhoid)

1st investigation

stool cultures with ova and parasites:
positive for pathogenic organisms[24]
More

Other investigations

duodenal biopsy:
positive for pathogenic organisms[28]
More
CD4 cell count:
normal or low
More

Irritable bowel syndrome

History

long history of diarrhoea, constant or intermittent, without alarm features or night waking; bouts of diarrhoea coincide with anxiety/stress, family history of irritable bowel syndrome; bloating, flatulence, and crampy abdominal pain relieved by defecation may be present; diarrhoea may coexist with periods of constipation; Rome criteria (set of guidelines that outlines symptoms and applies parameters such as frequency and duration to make possible a more accurate diagnosis) useful when considering irritable bowel syndrome[33][34][35]

Exam

mild abdominal distention or tenderness; patients may demonstrate hyperalgesia and allodynia (pain with non-painful stimuli, e.g., on light palpation or touching the abdominal wall)

1st investigation

colonoscopy:
normal
More
IgA-tissue transglutaminase (tTG):
normal
More

Other investigations

breath tests for bacterial overgrowth and lactose intolerance:
normal
More
oesophagogastroduodenoscopy:
normal
More
faecal calprotectin:
low
More
Has been shown to consistently differentiate inflammatory bowel disease from irritable bowel syndrome in undiagnosed, symptomatic patients.[4][7][8]

Irritable bowel syndrome

Drug effects

History

on a medication that is known to cause diarrhoea; typically proton pump inhibitors, non-steroidal anti-inflammatory drugs, metformin, and quinine; in many cases, patients on multiple medications; time of onset can be very variable, so can be difficult to pinpoint offending agent[1][36][37]

Exam

generally non-specific

1st investigation

trial of discontinuation of suspected medication:
improvement in symptoms upon discontinuation of drug
More

Other investigations

Faecal impaction

History

colonic obstruction due to malignancy or severe motility disorder causing faecal impaction and overflow diarrhoea, usually history of severe or worsening constipation; cramping, gas, and abdominal pain common[1]

Exam

hard faecal mass may be noted on rectal examination

1st investigation

plain abdominal x-ray:
large amount of faeces

Other investigations

Constipation

Coeliac disease

History

family history of coeliac disease or personal history of other autoimmune diseases, especially type 1 diabetes mellitus or autoimmune thyroid disease; presenting symptoms, especially in adults, are highly variable; classic symptoms include diarrhoea, abdominal pain, weight loss, fatigue or lethargy, nausea or vomiting, bloating or excess intestinal gas[38][39][40][41]

Exam

non-specific; dermatitis herpetiformis (a pruritic, vesicular rash over the extensor surfaces) if found, highly suggestive; aphthous mouth ulceration

1st investigation

IgA-tissue transglutaminase (tTG):
elevated (>20 units)
More

Other investigations

duodenal biopsy:
increased intraepithelial lymphocytes, villous atrophy, and crypt hyperplasia
More
capsule endoscopy:
villous atrophy, mosaic mucosal pattern, scalloping of folds, micronodularity

Coeliac disease

Crohn's disease

History

chronic abdominal pain, bloating, and weight loss may occur; family history of inflammatory bowel disease[10][11][12][13]

Exam

generally non-specific; may include distention consistent with a stricture and obstruction, abdominal masses secondary to abscess or phlegmon, abdominal or perirectal fistulae, or skin lesions including erythema nodosum or less commonly pyoderma gangrenosum

1st investigation

endoscopy/colonoscopy with biopsy:
mucosal lesions consistent with colitis and/or enteritis[10]
More

Other investigations

small bowel follow through:
strictures, lesions in small bowel
capsule endoscopy:
inflammation, ulceration
faecal calprotectin:
elevated
More
Has been shown to consistently differentiate inflammatory bowel disease from irritable bowel syndrome.[4][7][8] However, faecal calprotectin can also be elevated in some cases of colorectal cancer, gastrointestinal infection, or with use of non-steroidal anti-inflammatory drugs.[4]

Crohn's disease

Bile salt malabsorption

History

surgical history of resection of a section of ileum usually >50 cm; can occur in the absence of surgery and ileal disease (termed idiopathic bile salt malabsorption, it is believed to be due to abnormalities of the apical bile salt transporter located in ileal enterocytes)[1][42][43][44][45][46][47]

Exam

surgical scars on abdomen may be present

1st investigation

75-selenium-23-selena-25-homotaurocholic acid test (SeHCAT):
abnormally low retention level at 7 days is suggestive of bile salt malabsorption
More

Other investigations

trial of low-fat, medium-chain triglyceride-supplemented diet:
significant and lasting improvement of symptoms suggests cause related to bile salt deficiency or advanced liver disease
serum 7-hydroxycholesterol:
elevated
trial of cholestyramine:
diarrhoea resolves

Brush border enzyme deficiency (lactose, fructose, sucrose, isomaltase)

History

diarrhoea often occurs along with bloating, cramping, wind, and flatulence; onset usually within 1 hour of ingesting offending substance; only lactose is typically easily identifiable as discrete exposures; symptoms often gradual, becoming increasingly severe in early adulthood; may present more suddenly after an acute insult (infectious gastroenteritis)[48][49][50]

Exam

usually non-specific; signs of weight loss and anaemia should not be present

1st investigation

diet record with elimination diet:
prompt resolution of symptoms with avoidance of offending substance

Other investigations

hydrogen breath testing:
rise of >20 ppm from baseline within 2 hours after the suspected offending sugar is ingested
More
lactose tolerance test:
precipitation of symptoms by lactose ingestion
More

Small intestinal bacterial overgrowth

History

history of diabetes, past surgery, coeliac or Crohn's disease; typical symptoms are bloating, wind, flatulence, cramping, and mild to moderate diarrhoea[1][51][52][53][54]

Exam

generally non-specific

1st investigation

breath test:
a rise of >20 ppm of hydrogen or methane (or both) within 90 minutes is considered a positive result
More
Bacterial fermentation of non-digestible sugars in the colon produces hydrogen and methane. If fermentation occurs in the small intestine, a rise in hydrogen and methane occurs earlier.[55] False positive tests can occur if gastrointestinal transit is rapid.[56]Hammer HF, Fox MR, Keller J, et al. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus. United European Gastroenterol J. 2022 Feb;10(1):15-40.
Sensitivity is 42.0% to 54.5% and specificity is 70.6% to 83.2%.[57]
Evidence for breath testing is contradictory, but recommended before antibiotic use in patients with weaker risk factors (e.g., proton pump inhibitor use, diabetes, gastroparesis).
therapeutic trial of antibiotics:
significant and lasting improvement of symptoms suggests small intestinal bacterial overgrowth
More
Recommended first-line by UK guidelines because of poor sensitivity and specificity of breath test.[4] Also used if breath testing not available and other aetiologies ruled out.[53]

Other investigations

Pancreatic insufficiency

History

history of pancreatitis, alcohol misuse, or cystic fibrosis; onset typically gradual but progressive[1][58][59][60]

Exam

generally non-specific

1st investigation

faecal elastase:
positive if approximately ≤200 micrograms/g
More
70% to 90% sensitive and specific. This is a direct test of pancreatic enzyme production. Low level is suggestive of overall pancreatic exocrine insufficiency.[59]
Cutoff level is approximate as some patients with lower values will not have malabsorption and others with higher levels will develop symptoms.

Other investigations

faecal chymotrypsin:
positive if approximately ≤6 units/g
More
50% to 70% sensitive and specific. This is a direct test of pancreatic enzyme production. Low level is suggestive of overall pancreatic exocrine insufficiency.[60]
Cutoff level is approximate as some patients with lower values will not have malabsorption and others with higher levels will develop symptoms.
MRI abdomen:
may reveal pancreatic calcifications
More
CT abdomen:
may reveal pancreatic calcifications
More
ultrasound of pancreas:
may reveal pancreatic calcifications
More
therapeutic trial with pancreatic enzyme replacement:
significant and lasting improvement of symptoms suggests pancreatic insufficiency
More

Chronic pancreatitis

Alcohol

History

history of excessive alcohol ingestion

Exam

smell of alcohol present or intoxication evident; clinical features of liver disease (e.g., jaundice, spider angiomata, Dupuytren's contractures, palmar erythema, gynaecomastia, ascites)

1st investigation

blood alcohol level:
may be elevated
LFTs:
all parameters may be elevated

Other investigations

hepatic ultrasound:
may show hepatomegaly, fatty liver, liver cirrhosis, liver mass, splenomegaly, ascites, evidence of portal hypertension

Hyperthyroidism

History

may be history of other autoimmune disease, increased appetite, weight loss, heat intolerance, and hair loss[61][62][63]

Exam

fine tremor, goitre, exophthalmos, tachycardia, or hypertension in severe cases

1st investigation

thyroid stimulating hormone:
suppressed
More

Other investigations

free thyroid hormones:
increased
thyroid radioactive iodine or technetium-99 uptake scan:
diffuse increased uptake in Graves disease, reduced uptake in subacute thyroiditis

Overview of thyroid dysfunction

Diabetes mellitus

History

history diabetes mellitus usually known; nausea and early satiety may be present (indicating gastroparesis, suggesting long-standing diabetes); chronic diarrhoea is uncommon as presenting symptom of new-onset diabetes[64][65][66]

Exam

generally non-specific; in patients with diabetes, neuropathy, nephropathy, and retinopathy are often present by the time gastrointestinal (GI) symptoms manifest

1st investigation

HbA1c:
48 mmol/mol (6.5%) or greater
plasma glucose:
elevated
motility studies: gastric emptying, small intestinal transit time, colonic (sitz marker study, anorectal manometry):
evidence of abnormally fast or slow intestinal transit
More

Other investigations

Overview of diabetes

Radiation enteritis/colitis

History

significant radiation exposure to the abdomen, most commonly for prostate cancer in men and uterine cancer in women; haematochezia common[67][68][6]

Exam

generally non-specific

1st investigation

faecal occult blood test:
may be positive
More
colonoscopy:
loss of normal mucosal vasculature markings with friability and telangiectasia
More

Other investigations

small bowel follow through:
areas of thickening, stenosis, adhesions, and occasional fistula
More

Eosinophilic enteritis

History

any area of gastrointestinal tract may be involved, symptoms non-specific and variable including abdominal pain, nausea, vomiting, and diarrhoea; patient may have history of other allergic conditions including food sensitivities[69][70][71][72][73][74]

Exam

generally non-specific

1st investigation

endoscopy and/or colonoscopy with biopsy:
histology should reveal a thickened submucosa with >20 eosinophils per high-powered field[70]
More

Other investigations

CT or small bowel follow through:
areas of thickening can occur in any area of the intestinal tract
More
serum eosinophil count:
may be elevated

Chronic ischaemic colitis

History

older patient with a history of vascular disease and on antihypertensive medications; cramping abdominal pain and mild to severe haematochezia common[75][76][77]

Exam

generally non-specific; abdominal tenderness may be present and blood may be seen on rectal examination

1st investigation

colonoscopy:
mucosal congestion/haemorrhage in the area of the splenic flexure
More

Other investigations

CT abdomen/pelvis:
thickening of the colon in the area of the splenic flexure
More

Surgical bypass or resection

History

history of major gastrointestinal surgery; diarrhoea from short gut syndrome due to long length resections or due to dumping syndrome in which the primary disorder is of motility[78][79][80][81]

Exam

scars should be notable on the abdomen from prior surgery; otherwise, examination is generally non-specific

1st investigation

no initial test:
diagnosis is based on history
More

Other investigations

vitamin B12 levels following ileal resection:
low
More
serum iron following large duodenal/jejunal resection:
low
More

Uncommon

Non-steroidal anti-inflammatory drug enteropathy

History

may be on Non-steroidal anti-inflammatory drugs (NSAIDs) for any length of time prior to onset of symptoms; may present like inflammatory bowel disease with watery or bloody diarrhoea[36][82][83][84][85]

Exam

generally non-specific

1st investigation

endoscopy/colonoscopy:
absence of specific findings
More

Other investigations

capsule endoscopy:
may reveal mucosal abnormalities/erosions
cessation of NSAID:
resolution of symptoms within 2 to 4 weeks
More

Infiltrating malignancy

History

rapid weight loss common; may be symptoms of anaemia (e.g., fatigue, dizziness); haematochezia and/or pain may also be present depending on size and location of the lesions[1][86][87]

Exam

usually non-specific; cachexia and signs of anaemia (e.g., pallor) may be present

1st investigation

CT abdomen/pelvis:
may reveal mucosal thickening or mass lesion

Other investigations

endoscopy/colonoscopy:
may be targeted for biopsy if lesion seen on prior imaging

Protein-losing enteropathy

History

leg swelling, abdominal pain, weight loss, rectal bleeding, history immune deficiency with recurrent infections; history of the underlying disease (connective tissue disease, amyloidosis, congestive heart failure, constrictive pericarditis, ulcerative colitis)[88]

Exam

cachexia, pallor, oedema; features of underlying disease (connective tissue disease, amyloidosis, congestive heart failure, constrictive pericarditis, ulcerative colitis)

1st investigation

stool alpha-1-antitrypsin:
present

Other investigations

endoscopy/colonoscopy:
evidence of underlying mucosal disease

Graft-versus-host disease

History

history of prior allogenic bone marrow transplant; may occur more than 1 year post-transplant; other manifestations, such as dermatitis and liver involvement, typical in patients who develop intestinal involvement[89][90][91]

Exam

generally non-specific; patients will often have a maculopapular skin rash that may progress to generalised erythroderma and in severe cases bullous formation with desquamation

1st investigation

biopsy of affected area (skin/liver/intestine):
active colitis or enteritis with increased crypt apoptosis, degenerated crypts, and epithelial regeneration
More

Other investigations

Graft-versus-host disease

Hodgkin's lymphoma

History

abdominal pain, nausea, vomiting, weight loss, anaemia, fever, night sweats; history prolonged coeliac disease, or clinical relapse of coeliac disease after prolonged period of good response to gluten avoidance[92]

Exam

non-specific; occasionally cachexia, pallor, lymphadenopathy, rash

1st investigation

CT scan:
staging tool; may show a mass, lymphadenopathy, or metastases
lymph node biopsy:
diagnostic histology

Other investigations

endoscopy/colonoscopy:
may show ulceration, nodules
polymerase chain reaction:
clonal Ig and T-cell receptor gene rearrangement
capsule endoscopy:
abnormal mucosal features
deep small bowel biopsy:
diagnostic histology

Hodgkin's lymphoma

Non-Hodgkin's lymphoma

History

Exam

non-specific; occasionally cachexia, pallor, lymphadenopathy, rash

1st investigation

CT scan:
staging tool; may show a mass, lymphadenopathy, or metastases
lymph node biopsy:
diagnostic histology

Other investigations

endoscopy/colonoscopy:
may show ulceration, nodules
polymerase chain reaction:
clonal Ig and T-cell receptor gene rearrangement
capsule endoscopy:
abnormal mucosal features
deep small bowel biopsy:
diagnostic histology

Non-Hodgkin's lymphoma

Tropical sprue

History

residence or travel for longer than 1 month in endemic area, primarily south and south-east Asia and the Caribbean; steatorrhoea and weight loss are often present[93][94][95]

Exam

generally non-specific

1st investigation

stool culture and serological testing for infections:
negative for common pathogens
More
Infectious diarrhoea must be ruled out in all cases of suspected tropical sprue for common pathogens including Giardia, entamoebae, and cryptosporidium.[93] Testing should be directed according to local infectious epidemiology.

Other investigations

endoscopy with duodenal biopsy:
macroscopic scalloping may be seen; histology reveals villous blunting, crypt hyperplasia, and increased intraepithelial lymphocytes
More
Villous atrophy is generally less severe than coeliac disease, and generally affects individuals not predisposed to coeliac disease. However, differentiation between the 2 disorders often requires serological testing for coeliac disease, and occasionally therapeutic trial of treatment for tropical sprue.[94]

Tropical sprue

Lymphangiectasia/impaired lymphatic drainage

History

diarrhoea with or without steatorrhoea and nausea/vomiting in childhood or early adulthood; may be history of infection (e.g., tuberculosis), lymphoma, cardiac disease, or use of certain chemotherapeutic agents; easy bruising or night blindness may be noted[96]

Exam

peripheral oedema may be present

1st investigation

alpha-1 antitrypsin excretion in 24-hour stool collection:
>24 mL/day without diarrhoea or >56 mL/day with significant diarrhoea
More

Other investigations

CT scan with lymphangiography:
imaging constant with intestinal lymphangiectasia

Hypoparathyroidism

History

fatigue, poor sleep, myalgias, unsteady gait, anxiety, depression, memory loss, constipation, muscle cramps, paraesthesias, abdominal pain; may be a history of osteopenia or osteoporosis and kidney stones

Exam

hyper-reflexia, tetany, surgical scars of thyroidectomy

1st investigation

serum intact parathyroid hormone:
low
serum calcium:
low
serum phosphate:
low or normal

Other investigations

bone radiography:
hyperostosis, soft tissue calcification
brain CT:
may show basal ganglia calcification

Hypoparathyroidism

Addison's disease

History

fatigue, weakness, weight loss, anorexia

Exam

skin hyperpigmentation, hypotension, hair loss in females

1st investigation

synthetic ACTH stimulation test:
low basal cortisol and/or failure to raise endogenous cortisol appropriately

Other investigations

adrenal CT:
normal or atrophy, calcification, or enlargement due to infiltration
serum electrolytes:
low sodium, elevated potassium, elevated calcium
insulin hypoglycaemia test:
abnormal

Addison's disease

Gastrinoma

History

may have history of weight loss or flushing; occurs in syndromes involving other endocrine tumours in family members or multiple tumours in an individual (e.g., multiple endocrine neoplasia syndrome)[62][63][97][98]

Exam

hypertension, wheezing indicative of bronchospasm

1st investigation

24-hour urinary excretion of 5-hydroxyindoleacetic acid:
>523 micromol/dL (100 mg/day)
More
fasting gut hormone profile:
abnormal
More

Other investigations

octreotide scan (somatostatin receptor scintigraphy):
concentration of radioactivity at tumour site
More
gastrin level:
highly elevated
More
Levels >477 picomol/L (1000 picogram/mL) are highly suggestive.[99] Secretin stimulation results in paradoxic elevation in gastrin levels with gastrinoma.[97]
secretin stimulation test:
rise in gastrin level of ≥95.4 picomol/L (200 picogram/mL) or >50% from baseline within 30 minutes
More
glucose and electrolytes:
variable

Multiple endocrine neoplasia syndromes

Carcinoid tumours

History

Exam

hypertension, wheezing indicative of bronchospasm

1st investigation

24-hour urinary excretion of 5-hydroxyindoleacetic acid:
>523 micromol/dL (100 mg/day)
More
fasting gut hormone profile:
abnormal
More

Other investigations

octreotide scan (somatostatin receptor scintigraphy):
concentration of radioactivity at tumour site
More
gastrin level:
highly elevated
More
secretin stimulation test:
rise in gastrin level of ≥95.4 picomol/L (200 picogram/mL) or >50% from baseline within 30 minutes
More
glucose and electrolytes:
variable

Carcinoid syndrome

VIPomas

History

Exam

hypertension, wheezing indicative of bronchospasm

1st investigation

24-hour urinary excretion of 5-hydroxyindoleacetic acid:
>523 micromol/dL (100 mg/day)
More
fasting gut hormone profile:
abnormal
More

Other investigations

octreotide scan (somatostatin receptor scintigraphy):
concentration of radioactivity at tumour site
More
gastrin level:
highly elevated
More
secretin stimulation test:
rise in gastrin level of ≥95.4 picomol/L (200 picogram/mL) or >50% from baseline within 30 minutes
More
glucose and electrolytes:
variable

VIPoma

Abetalipoproteinaemia

History

in infancy, diarrhoea is associated with poor growth and poor weight gain; later in life poor muscle coordination, ataxia, and visual impairment common[100][101]

Exam

physical examination may reveal ataxia, visual impairment, and other neurological abnormalities

1st investigation

serum beta-lipoprotein:
absent

Other investigations

chylomicron level:
low
MTTP gene testing:
presence of gene mutation

Abetalipoproteinaemia

Advanced liver disease

History

history of advanced liver disease from any cause including alcohol, fatty liver, autoimmune, and infectious; although the diarrhoea associated with advanced liver disease is rarely life threatening, it often portends end-stage liver disease and evaluation and treatment should be expedited[1][42][43][44][45][46]

Exam

stigmata of chronic liver disease may be present, including spider angioma, palmar erythema, jaundice, and ascites

1st investigation

trial of low-fat, medium-chain triglyceride-supplemented diet:
significant and lasting improvement of symptoms suggests cause related to bile salt deficiency or advanced liver disease

Other investigations

Cirrhosis

Common variable immune deficiency

History

can occur at any age; presence of multiple skin or respiratory tract infections common[102][103][104][105]

Exam

generally non-specific

1st investigation

serum Ig levels:
low
More

Other investigations

duodenal biopsy:
villous atrophy, crypt hyperplasia without increased intraepithelial lymphocytes
More

Hypogammaglobulinaemia

Amyloidosis

History

presence of condition associated with developing amyloidosis such as multiple myeloma, chronic inflammatory diseases, and chronic renal failure; gastrointestinal (GI) bleeding, GI obstruction, and motility disorders[106][107][108]

Exam

generally non-specific; however, macroglossia, enlargement of the anterior shoulder, ecchymoses, or subcutaneous nodules may be seen[107]

1st investigation

urine/serum protein analysis:
presence of monoclonal protein in the serum or urine (Bence Jones proteins)

Other investigations

tissue biopsy of duodenal or colorectal mucosa:
apple-green birefringence of amyloid under polarised light
More
fat pad biopsy:
apple-green birefringence of amyloid under polarised light
More

Amyloidosis

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Assessment of chronic diarrhoea

Differentials

Common

Ulcerative colitis

History

Exam

1st investigation

Other investigations

Microscopic colitis (lymphocytic colitis and collagenous colitis)

History

Exam

1st investigation

Other investigations

Viral, bacterial, parasitic, HIV enteropathy

History

Exam

1st investigation

Other investigations

Irritable bowel syndrome

History

Exam

1st investigation

Other investigations

Drug effects

History

Exam

1st investigation

Other investigations

Faecal impaction

History

Exam

1st investigation

Other investigations

Coeliac disease

History

Exam

1st investigation

Other investigations

Crohn's disease

History

Exam

1st investigation

Other investigations

Bile salt malabsorption

History

Exam

1st investigation

Other investigations

Brush border enzyme deficiency (lactose, fructose, sucrose, isomaltase)

History

Exam

1st investigation

Other investigations

Small intestinal bacterial overgrowth

History

Exam

1st investigation

Other investigations

Pancreatic insufficiency

History

Exam

1st investigation

Other investigations

Alcohol

History

Exam

1st investigation

Other investigations

Hyperthyroidism

History

Exam

1st investigation

Other investigations

Diabetes mellitus

History

Exam

1st investigation

Other investigations

Radiation enteritis/colitis

History