Etiology of chronic diarrhea

OBJECTIVE: The aim is to find the common causes of chronic diarrhea in our hospital, and to find out the most useful methods for diagnosis. METHODS: This study was carried out in the medical ward at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, during the period January 1999 through to August 2000. Fifty inpatients with diarrhea for 4 weeks or more were evaluated by history, physical examination and investigations which included endoscopy with biopsy. RESULTS: The first cause of chronic diarrhea was ulcerative colitis (28%), the next was celiac disease (20%), followed equally by microscopical colitis (12%) and functional diarrhea (12%), amebiasis was the 5th cause (10%), followed by carcinoma of the colon (6%), Crohn's disease (2%), diabetic diarrhea (2%) and thyrotoxicosis (2%). Endoscopy (esophagoduodenoscopy, sigmoidoscopy and colonoscopy) with biopsy was the most useful method to diagnose >70% of the cases as ulcerative colitis, celiac disease, microscopic colitis, carcinoma of the colon and Crohn's disease. CONCLUSION: This study revealed the importance of history taking, physical examination, and judious and sequential use of investigations especially endoscopic procedures to discover the cause of chronic diarrhea. Chronic bloody diarrhea should raise the high possibility of ulcerative colitis. A considerable number of patients with chronic diarrhea in our study were discovered to have microscopical colitis.