Gut 56:1756-1757 doi:10.1136/gut.2007.138867
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Chronic diarrhoea

This is an introduction to the Gut tutorial “Chronic diarrhoea” hosted on BMJ Learning—the best available learning website for medical professionals from the BMJ Group.

Diarrhoea predominant irritable bowel syndrome is by far the most common cause of abdominal pain and diarrhoea in patients aged 20 to 40 years. Irritable bowel syndrome as a whole affects around 10% of the UK population. The female to male ratio is 1.5:1. Between 6 and 17% of patients with irritable bowel syndrome report that their symptoms began after an attack of acute bacterial gastroenteritis. Indeed, bacterial gastroenteritis in the previous year proved to be the strongest predictor of the development of irritable bowel syndrome. Around 3% of patients meeting the Rome criteria for irritable bowel syndrome have been shown to suffer from unrecognised coeliac disease. Although initially asymptomatic, many patients, when put on a gluten free diet, recognise that they have been tolerating low grade symptoms for many years. The yield from further investigations is small but occasionally of value. In patients with an established diagnosis of irritable bowel syndrome, 2% of stool samples were abnormal and around 2% of colonoscopies show occult or microscopic inflammatory bowel disease. Lactose intolerance is commonly diagnosed, but may be unhelpful in management in the UK because many patients with lactose intolerance have learnt to avoid foods that contain lactose. Unlike irritable bowel syndrome, Crohn’s disease is marked by characteristic weight loss, abdominal tenderness or mass with perianal soreness and discolouration. Anaemia and raised inflammatory markers, such as C reactive protein and erythrocyte sedimentation, are tests that discriminate irritable bowel syndrome from patients with other illnesses.

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  • Competing interests: None.