The Self-Limited Nature of Chronic Idiopathic Diarrhea

Little is known about the clinical presentation and natural history of previously healthy patients in whom chronic idiopathic diarrhea develops. We reviewed the case records of 152 patients with chronic diarrhea who had no history of gastrointestinal surgery and who were evaluated in detail as part of a chronic-diarrhea protocol from 1985 to 1990. Patients were considered to have chronic idiopathic diarrhea if they had persistently loose stools for more than four weeks, no systemic illness, and no identifiable cause of diarrhea. Seventeen patients (10 men and 7 women) ranging in age from 33 to 72 years met the criteria for chronic idiopathic diarrhea. Each patient had a history of a relatively abrupt onset of symptoms, often soon after returning home from a trip, starting two to seven months before evaluation. Their diarrhea did not occur during a local outbreak of diarrhea, and other family members did not become ill. Stool frequency ranged from 5 to 25 movements per day, stool weights ranged from 417 to 1480 g per day, and fecal electrolyte and osmolality values were consistent with a diagnosis of secretory diarrhea. The results of biopsies of the small intestine and colon were normal, as were small-bowel roentgenograms. Extensive studies for infectious causes of diarrhea were negative, and no patient responded to antibiotic therapy. In every patient the diarrhea stopped without specific therapy after 7 to 31 months (mean, 15) and did not recur during a follow-up period averaging 38 months. Sporadic idiopathic chronic diarrhea is a recognizable syndrome that can last many months, but is self-limited. (N Engl J Med 1992;327:1849–52.), THERE are many well-described causes of chronic diarrhea, but in some patients no cause can be found, even after exhaustive diagnostic studies.^{1 2 3 4 5} These patients often become alarmed at the prospect of endless diarrhea, usually fear they have cancer, and continue to seek an answer to their problem. Doctors also become concerned when dealing with these patients for fear of missing a diagnosis, despite many negative tests, and may undertake increasingly risky interventions. The purpose of this study was to define the clinical manifestations and natural history of chronic idiopathic diarrhea. To do this, we reviewed the records of patients with…