Evaluation of Patients with Diarrhea and Timing of Referral

Summary

Diarrhea is a universal human experience, that is, a symptom and not a disease (Schiller LR, Sellin JH. Approach to a patient with symptoms and signs: diarrhea. In: Sleisenger and Fordtran’s gastrointestinal and liver disease, 9th edn. Philadelphia, PA: Saunders, Elsevier, 2010, pp. 159–186). Most patients with diarrhea can be managed successfully as outpatients; however, more than 450,000 hospital admissions each year are for gastroenteritis (Schiller LR, Sellin JH. Approach to a patient with symptoms and signs: diarrhea. In: Sleisenger and Fordtran’s gastrointestinal and liver disease, 9th edn. Philadelphia, PA: Saunders, Elsevier, 2010, pp. 159–186). The evaluation of patients with diarrhea is complex. A detailed and carefully taken history is essential to aid in the classification of diarrhea. Appropriately defining and classifying diarrhea is an essential first step that provides the clinician a framework for approaching diagnostic and therapeutic options. There are several methods to classify diarrhea and no single method of classification is ideal. The most frequently used methods of classification are as follows: by time course (acute or chronic), volume (large or small), pathophysiology (secretory or osmotic), stool characteristics (watery, fatty, inflammatory), and/or epidemiology (travel related, immune suppression, epidemic). Based on above classification methods, a rational approach can be used by the primary care physician to further manage patients with diarrhea, including when to consider referral to a gastroenterologist.