Diarrhea Types, Causes, Symptoms And Treatment

The passage of three or more unformed stools per day is called diarrhea. In other words, diarrhea is the passage of more than 250 g of unformed stool per day. It is reported that more than 350,000 children die annually in Pakistan due to diarrhea. According to a report, approximately 53,000 children under five years of age lost their lives due to diarrhea. Diarrhea itself is basically not a disease but an underlying symptom of other GIT infections such as pseudomembranous colitis. Over 700 drugs have been implicated in causing diarrhea. It accounts for about 7% of all adverse effects of drugs.

Types

There are three main types of diarrhea depending upon the duration of action,

1. Acute diarrhea

If the diarrhea is present for less than 14 days, then it is termed as an acute form of diarrhea.

2. Chronic diarrhea

If the diarrhea is present for greater than 29 days, then it is termed as chronic diarrhea.

3. Persistent diarrhea

If the diarrhea is present between 14 to 29 days, then it is called persistent diarrhea.

There are seven main types of diarrhea depending upon the causative agent,

1. Traveller’s diarrhea

If the diarrhea is caused by E. coli, then it is called traveller’s diarrhea.

2. Drug Induced diarrhea

If the diarrhea is caused by antibiotics, then it is termed drug induced diarrhea. For example, C. difficile diarrhea.

3. Cholera associated diarrhea

If the diarrhea is associated with cholera then it is called cholera associated diarrhea. For example, V. cholera.

4. Gluten Intolerance based diarrhea

Some people are unable to digest gluten, as a result diarrhea occurs.

5. Lactase deficiency based diarrhea

Some people have the deficiency of lactase enzyme, then they are unable to digest lactose found in milk, as a result diarrhea occurs. 

6. Chemotherapy based diarrhea

Patients receiving chemotherapy suffers from diarrhea, this is called chemotherapy induced diarrhea.

7. Cancer or tumor based diarrhea

Sometimes diarrhea occurs as a side effect of cancer or tumor, it is termed cancer or tumor induced diarrhea.

Other types of diarrhea includes,

1. Osmotic diarrhea

Water absorption depends upon the absorption of solutes in the intestine.  If solutes are retained in the intestinal lumen in excessive amounts, then water will not be absorbed and diarrhea will occur.

2. Secretory diarrhea

Large volumes of water are normally secreted into the small intestine. But a large amount of this water is efficiently absorbed before reaching the large intestine. Diarrhea occurs when the secretion of water exceeds its absorption into the intestine.

3. Diarrhea associated with deranged motility

Due to the disorder in motility that accelerates transit time can cause the reduction in the absorption. As a result, diarrhea occurs even if the absorptive process is proceeding normally.

4. Infectious diarrhea

Due to the disruption of the intestinal epithelium caused by microbial or viral pathogens is a very common cause of diarrhea in all species.

Causes

Diarrhea in most of the cases is caused by,

• Poor quality water
• Sanitation
• Poor hygiene especially hand washing
• Poultry
• Livestock
• Uncooked food
• Dairy
• Soil
• Feces of animals and infected persons

Bacteria that causes diarrhea includes diarrheagenic escherichia coli, campylobacter jejuni, vibrio cholera O1, vibrio cholera O139, shigella species, bacteroides fragilis, nontyphoidal salmonellae, clostridium difficile and Yersinia enterocolitica. The virus responsible for the development of diarrhea includes rotavirus, norovirus, adenovirus, astrovirus and cytomegalovirus. The parasites that can cause diarrhea includes cryptosporidium parvum, giardia intestinalis, microsporidia and entamoeba fragilis.

Symptoms

The clinical presentation of diarrhea includes the symptoms of,

• Loose or watery stools
• Severe Dehydration
• Anorexia
• Nausea, Vomiting
• Abdominal Cramps
• Fever, Chills, Malaise
• Sweating, Pain
• Bloody Stool
• Rarely Arthritis
• Hemolytic Uremic Syndrome (HUS)

Treatment

The management of the diet is a first priority for treatment of diarrhea. You must stop solid food and consume soft food. Try to avoid dairy products if you have diarrhea. If vomiting is severe then don’t take any oral food. When the bowel movement decreases then you should begin the diet. You should treat vomiting with conventional anti-emetics. You must continue feeding in children as they are more susceptible to decrease body weight. There is a stepwise approach to treat diarrhea,

Oral Rehydration Therapy & IV Fluids

The formula recommended for ORS by the World Health Organization (WHO) contains glucose, sodium, potassium, chloride and bicarbonate in an almost isotonic fluid. In adults, 2 L of oral rehydration fluid should be given in the first 24 h, followed by unrestricted normal fluids with 200 mL of rehydration solution per loose stool or vomit. For children, 30–50 mL/kg of an ORS should be given over 3–4 h. Then you should take 10ml/kg of oral rehydration fluid per loose stool or vomit.

Intravenous Rehydration Therapy

If there is a decreased level of consciousness or if dehydration is severe, then intravenous delivery may be required. Intravenous rehydration therapy includes ringer lactate infusion, ringer lactate infusion with 5% dextrose, 5% dextrose with electrolytes, dextrose plus sodium chloride and normal saline 0.9%.

Antimotility Agents

Antimotility agents are used for symptomatic treatment in moderate to severe diarrhea. They should not be used in children because they can precipitate ileus or toxic megacolon. Drugs included are loperamide, diphenoxylate, atropine, codeine and morphine

Bismuth Subsalicylate

Bismuth subsalicylate should be given in adults in the doses of 524 mg orally every 30 to 60 minutes. It should not be exceeded to 8 doses in any 24 hour period. The dose of bismuth subsalicylate in children is 87 mg to 262 mg every 30 minutes to 1 hour as needed.

Zinc

Zinc supplements should be given in 20 mg per day for 10 days in children older than two months. They play a crucial role in treating and preventing acute diarrhea. (Research Article)

Antibiotics

They are not always recommended for bacterial diarrhea. For example, non-typhoidal salmonella gastroenteritis in immune-competent patients usually causes self-limited diarrhea. Antibiotics do not significantly shorten the course in this case. They should only be used for newborns up to 6 months, older above 50 years, persons with a prosthesis, valvular heart disease, severe atherosclerosis, cancer, or uremia. Antibiotics may be selected depending upon the stool culture.

Probiotics

Probiotics stimulates the immune system and acts against pathogens by competing for binding sites on intestinal epithelial cells. They are very effective in children.

Octreotide

Serotonin blockers are given in carcinoid tumors in 100 to 600 mcg/day subcutaneously for 2 weeks.

Absorbents

Ispaghula husk and attapulgite are effective as adsorbents in mild to moderate diarrhea.

Vaccination

Rotavirus vaccine is proved to be very effective against most common strains of rotavirus (G1 and G3).