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Chronic diarrhoea
  1. Robin Spiller
  1. Division of Gastroenterology, University of Nottingham, Nottingham, NG7 2UH, UK

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This 32 year old female school teacher was referred because of longstanding diarrhoea and abdominal pain with recent exacerbation. She had a normal bowel habit, opening her bowels once a day until the age of 26 when she suffered acute bacterial gastroenteritis while on a backpacking holiday in one of the US National Parks. Her main complaint was of colicky lower abdominal pain, which often preceded the urge to defecate.

This pain was usually but not always relieved by defecation. She opened her bowels up to 12 times per day, on awakening and soon after each main meal of the day with occasional bowel movements at other times. She was not often awakened by the need to defecate at night although she did suffer from disturbed sleep. The stool consistency was variable, mainly loose but sometimes normal. She would occasionally pass mucous when the stool was hard. When she had frequent bowel movements there was often anal soreness and streaks of bright red blood on the toilet paper. She also complained of abdominal distension and bloating, worse towards the end of the day. Her appetite was poor and she had lost about 6 lb in weight over the past few months, during which time her symptoms had been worse. She completed a symptom diary which tells the story eloquently.

The purpose of this tutorial is to illustrate:

  • The likely causes of painful chronic diarrhoea

  • Symptom patterns and diagnostic tests for

  • coeliac disease

  • Lactose intolerance

  • Giardiasis

  • Irritable bowel syndrome

  • Crohn’s disease

  • Bile salt malabsorption

  • post cholecystectomy diarrhoea

  • Microscopic colitis

  • familiar with management of the above

This tutorial is hosted on BMJ Learning - the best available learning website for medical professionals from The BMJ Group.

To access the tutorial, please use [Take this module on BMJ Learning] link from the online article content box or table of contents.