Understanding Gastroesophageal Reflux Disease(GERD)

Diarrhea: Types, Causes, Symptoms & Treatment

Study About Diarrhea In Detail- Medical & Health 

Diarrhea

The passing of loose, unformed, or watery stools, somewhere around three times each day is referred to as diarrhea. It could be joined by other enteric symptoms such as anorexia, nausea, vomiting, abdominal cramps, or bloating.

Diarrhea can also be defined as the entry of more than 250 g of unformed, free, or watery stools in a time of 24 hours. In other words, the condition is called diarrhea if the passage of loose or watery stools is increased than a person's usual bowel habit.

Viral or bacterial infections are the main causative agents of diarrhea. The most well-known cause of diarrhea in all age groups is Gastroenteritis. Gastroenteritis causes inflammation of your gastrointestinal tract, stomach, and intestine. Another common cause of diarrhea is traveler’s diarrhea.

Diarrhea itself is essentially not an illness. However, it is an underlying symptom or cause of other gastrointestinal infections (GIT) such as Pseudomembranous Colitis.  

The most prevalent condition of the gastrointestinal tract is diarrhea. Diarrhea affects the majority of people at some point in their lives and is frequently self-limiting. Diarrhea can either be the primary symptom of a more serious condition like ulcerative colitis, Crohn's disease, malabsorption, or bowel carcinoma or cause significant morbidity. Drug-induced diarrhea is diarrhea brought on by taking drugs or medication. Diarrhea is a common side effect of some medications, especially broad-spectrum antibiotics like ampicillin, erythromycin, and neomycin. Over 700 drugs have been linked to diarrhea, which accounts for about 7% of all adverse drug effects. While diarrhea may seem like a minor annoyance to some, it is responsible for the deaths of at least 2 million people worldwide each year, mostly children.

In Pakistan, approximately more than 350,000 children die annually in the country. According to a report, almost 53,000 children less than five years of age lost their lives earlier in 2013.

Diarrhea causes 4% of hospitalizations in youngsters and 5000 deaths due to foodborne illnesses yearly. Approximately, 89% of deaths from intense diarrheal ailment happen in people older than 65 years of age and more seasoned.

According to the report WHO distributed on second May 2017, diarrheal infection is the subsequent driving reason for death in kids under five years of age and is liable for killing around 525 000 kids each year.

Types Of Diarrhea

Here, we’ll discuss the most important and common types of diarrhea, 

Secretory Diarrhea

Huge volumes of water are typically secreted into the little intestinal lumen, yet a larger part of this water is efficiently ingested before arriving at the internal organ. Diarrhea happens when the secretion of water into the intestinal lumen surpasses absorption. By and large, secretory bowel issues won't resolve during a 2-multi day fast.

 Osmotic Diarrhea

Retention of water in the intestines is subject to satisfactory ingestion of solutes. On the off chance that unreasonable measures of solutes are held in the intestinal lumen, water won't be retained and loose bowels will result.

A typical illustration of malabsorption, distressing numerous grown-up people is lactose intolerance resulting from a lack of the enzyme lactase. In such cases, a moderate amount of lactose is burned-through (typically as milk), however, the intestinal epithelium is inadequate in lactase, and lactose can't be viably hydrolyzed into glucose and galactose for ingestion. The osmotically-dynamic lactose is held in the intestinal lumen, where it "holds" water.

A distinctive component of osmotic diarrhea is that it stops after the patient is abstained or quits devouring the inadequately retained solute.

Antibiotic-Associated Diarrhea (AAD)

Antibiotic-associated diarrhea (AAD) can be characterized as the unexplained beginning of diarrhea that happens with the administration of any antimicrobial drug. This type of diarrhea is usually diminished with fasting. It accounts for about 25% of medication-induced diarrhea.

Regularly, the gut is loaded up with a wide range of microbes. They keep each other in balance. Antibiotics destroy a portion of the microorganisms in the gut. This permits different microorganisms to develop excessively.

Sometimes, anti-toxins can permit a type of microbes called Clostridium difficile to develop excessively. This can prompt extreme, watery, and regularly wicked looseness of the bowels called pseudomembranous colitis.

The most commonly involved drugs in causing diarrhea are penicillin, clindamycin, antibiotic medications, erythromycin, cephalosporins, and so on.

Diarrhea Associated With Deranged Motility

In a request for supplements and water to be effectively consumed, the intestinal substance should be satisfactorily presented to the mucosal epithelium and held long enough to permit retention.

Issues in motility that speed up travel time could diminish retention, bringing about loose bowels regardless of whether the absorptive cycle was continuing appropriately. Alterations in intestinal motility (generally expanded drive) are seen in numerous kinds of looseness of the bowels.

Inflammatory & Infectious Diarrhea

The epithelium of the digestive tube is shielded from hurt by various systems comprising the gastrointestinal boundary, however, like numerous hindrances, it very well may be penetrated.

Interruption of the epithelium of the digestive tract because of microbial or viral microorganisms is a typical reason for loose stools in all species.

Obliteration of the epithelium results not just in the exudation of serum and blood into the lumen yet frequently is related to the far-reaching annihilation of absorptive epithelium. In such cases, absorption of water happens insufficiently, and the run results.

Instances of microorganisms oftentimes connected with irresistible looseness of the bowels include bacteria such as Salmonella, E. coli, and Campylobacter, protozoa such as coccidia species, Cryptosporidium, Giardia, and infections like coronavirus, rotaviruses, parvoviruses, and norovirus.

Diarrhea can also be classified based on the duration of symptoms,

1. Acute Diarrhea: If the duration of diarrhea lasts for more than 14 days, then it is termed acute diarrhea.
2. Persistent Diarrhea: If the duration of diarrhea lasts between 14-29 days, then it is termed persistent diarrhea.
3. Chronic Diarrhea: If the duration of diarrhea lasts for more than 29 days, then it is termed chronic diarrhea.

There are seven main types of diarrhea depending on the causative agent,

1. Traveler’s Diarrhea: If the diarrhea is caused by E. coli, then it is called traveler’s diarrhea.
2. Cholera-Associated Diarrhea: If the diarrhea is associated with cholera then it is called cholera-associated diarrhea. For example, V. cholera.
3. Chemotherapy-Based Diarrhea: Patients receiving chemotherapy can also develop diarrhea, this is called chemotherapy-induced diarrhea.
4. Drug-Induced Diarrhea: If the diarrhea is caused by antibiotics, then it is termed drug-induced diarrhea. For example, C. difficile diarrhea.
5. Gluten Intolerance-Based Diarrhea: Some people are unable to digest gluten, and as a result, diarrhea occurs.
6. Lactase Deficiency Based Diarrhea: Some people have a deficiency of lactase enzyme, then they are unable to digest lactose found in milk, resulting in diarrhea occurs. 
7. Cancer Or Tumor Based Diarrhea: Sometimes diarrhea develops as a side effect of cancer or tumor, it is termed cancer or tumor-induced diarrhea.

Causes Of Diarrhea

Diarrhea is a common digestive condition marked by frequent, loose, and watery bowel movements. The following variables and causes can all contribute to the development of diarrhea:

Infections: Bacterial, viral, or parasitic infections are among the most common causes of acute diarrhea. Pathogens like Escherichia coli (E. coli), Salmonella, Norovirus, and Giardia can lead to gastrointestinal infections.

Foodborne Illness: Consuming contaminated food or water, especially in unsanitary conditions, can introduce harmful microorganisms into the digestive system, causing diarrhea.

Traveler's Diarrhea: Traveling to regions with poor sanitation and unfamiliar bacteria can increase the risk of developing diarrhea, often referred to as traveler's diarrhea.

Dietary Factors: Certain foods or beverages, particularly those that are high in fiber, spicy, greasy, or dairy-based, can irritate the digestive tract and lead to diarrhea in sensitive individuals.

Food Allergies or Intolerances: Allergies to specific foods or intolerances to substances like lactose or gluten can result in digestive symptoms, including diarrhea.

Medications: Some medications, such as antibiotics, antacids containing magnesium, and certain cancer treatments, can disrupt the balance of beneficial gut bacteria and trigger diarrhea.

Stress and Anxiety: High stress levels or anxiety can lead to changes in bowel habits, potentially causing diarrhea or other digestive issues.

Medical Conditions: Chronic conditions like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), celiac disease, and diabetes can cause chronic or recurrent diarrhea.

Excessive Caffeine or Alcohol: Overconsumption of caffeine and alcohol can irritate the gastrointestinal lining, leading to diarrhea.

Gastrointestinal Surgery: Some individuals who have undergone gastrointestinal surgeries, such as gastric bypass surgery, may experience diarrhea as a side effect.

Laxative Abuse: The misuse or overuse of laxatives can lead to chronic diarrhea and disrupt normal bowel function.

Radiation Therapy: Radiation therapy to the abdomen or pelvis might result in radiation-induced diarrhea.

Inflammatory Conditions: Inflammation in the digestive tract due to conditions like Crohn's disease or ulcerative colitis can lead to chronic diarrhea.

Ingestion of Toxins: Exposure to toxins, such as certain chemicals or poisonous plants, can result in diarrhea.

Other Medical Conditions: Certain systemic illnesses, like hyperthyroidism or chronic kidney disease, can affect digestive processes and lead to diarrhea.

Symptoms Of Diarrhea

People diagnosed with diarrhea may develop the following symptoms,

• Frequent Bowel Movements: Diarrhea is typically defined by an increased frequency of bowel movements compared to a person's normal pattern.
• Watery Stools: Stools in diarrhea are often loose and watery in consistency, lacking normal solidity.
• Urgency: There is often a strong, sudden urge to have a bowel movement, making it challenging to wait.
• Abdominal Cramps: Diarrhea is sometimes accompanied by stomach pains or discomfort. These cramps may vary from modest to severe.
• Bloating: Some individuals experience abdominal bloating or a feeling of fullness in the abdomen.
• Nausea: Nausea is a common symptom that may accompany diarrhea, and in some cases, it can lead to vomiting.
• Fever: Depending on the underlying cause, diarrhea may be associated with a low-grade fever.
• Blood or Mucus: In some cases, blood or mucus may be present in the stool, indicating an underlying infection or inflammatory condition.
• Dehydration: Diarrhea can lead to dehydration due to the loss of fluids and electrolytes. Signs of dehydration may include dry mouth, dark urine, increased thirst, and dizziness.
• Weakness and Fatigue: Persistent diarrhea can lead to weakness and fatigue due to nutrient and fluid loss.
• Loss of Appetite: Diarrhea may result in a reduced appetite or aversion to food.
• Weight Loss: Chronic or severe diarrhea can lead to unintentional weight loss over time.

Diagnosis Of Diarrhea

Diagnosing diarrhea frequently involves a physical examination, a review of the patient's medical history, and, if required, laboratory testing. Here is a description of the procedure for diagnosing diarrhea:

Medical History Assessment

The healthcare provider will begin by taking a detailed medical history, which may include:
The duration and frequency of diarrhea episodes.

• Description of stool consistency (e.g., watery, loose, bloody, or mucus-containing).
• Any associated symptoms like abdominal pain, cramps, nausea, vomiting, or fever.
• Recent travel history (for possible travel-related infections).
• Dietary habits, including recent consumption of potentially contaminated or allergenic foods.
• Medications or supplements currently being taken.
• Any relevant medical conditions or previous gastrointestinal issues.

Physical Examination

To assess general health and find abnormalities or signs of dehydration, such as stomach discomfort, a physical examination will be conducted. It is possible to check vital signs including blood pressure, temperature, and heart rate.

Stool Examination

A stool sample may be collected and analyzed for various purposes, including:

• Detection of pathogens: Microscopic examination and cultures can identify bacteria, viruses, or parasites responsible for infectious diarrhea.
• Presence of blood or mucus: Testing can reveal any signs of gastrointestinal bleeding or inflammation.
• Ova and parasites: In cases of suspected parasitic infections, a specialized stool test may be performed.

Blood Tests

Blood tests may give vital information in establishing the root cause of diarrhea. These tests can be used to identify symptoms of infection, inflammatory sickness, or electrolyte imbalance. Imaging Studies: In certain cases, imaging studies such as abdominal X-rays or computed tomography (CT) scans may be ordered to evaluate the gastrointestinal tract for structural abnormalities or blockages.

Endoscopic procedures

Endoscopic procedures such as colonoscopy or upper endoscopy may be performed if the cause of diarrhea is unknown or inflammatory bowel disease is suspected. Such procedures provide direct imaging of the gastrointestinal system as well as tissue samples for biopsy.

Breath Tests

In some cases, hydrogen breath tests may be conducted to diagnose conditions like lactose intolerance or small intestinal bacterial overgrowth (SIBO).

Treatment Of Diarrhea

Acute infective diarrhea, including traveler's diarrhea, is usually a self-limiting disorder. However, depending on the causative agent, several complications may have to be dealt with. Dehydration and electrolyte disturbance can be readily treated but may if severe, progress to acidosis and circulatory failure with hypoperfusion of vital organs, renal failure, and death.

Toxic megacolon due to infective colitis has been documented; associated arthritis or Reiter's syndrome may complicate the invasive diarrheas of Campylobacter and Yersinia; Salmonella species may infiltrate bones, joints, meninges, and the gallbladder; and E. coli infection may, for example, be complicated by the hemolytic uraemic syndrome.

Management of the eating regimen is the main goal for the treatment of looseness of the bowels. Stop solid food, consume soft food, and avoid dairy products.

If vomiting is severe then, at that point don't take food orally. Not long after defecation diminishes, you should start the eating routine. Vomiting should be treated with conventional anti-emetics. Feeding should proceed in kids with intense bacterial diarrhea as they are more prone to reduce body weight.

Pharmacological Treatment Of Diarrhea

Antimotility Agents

In acute diarrhea, antimotility agents, for example, loperamide, diphenoxylate, and codeine are infrequently helpful for symptomatic therapy of loose bowels in individuals who have gentle to direct diarrhea. They will give help with related stomach cramps.

Antimotility agents are not suggested for use in kids. They ought to be kept away from serious gastroenteritis or looseness of the bowels as a result of the chance of hastening ileus or harmful megacolon.

Codeine And Morphine

Codeine and morphine are once in a while utilized because they can cause an obstruction as a result. These medications stay away from on account of the danger of medication abuse when they are utilized in enormous portions. They may cause resistance and mental and actual reliance.

Bismuth Subsalicylate

Bismuth subsalicylate is an insoluble complex of trivalent bismuth and salicylate. It ends up being powerful in lessening stool recurrence. It has antimicrobial action based on its bismuth content and antisecretory properties based on salicylate. It doesn't cause any side effects in the restorative/therapeutic portions.

Loperamide

Loperamide is the medication of choice because of its low CNS impact in treating diarrhea. It's anything but a synthetic opioid analog. It applies its activity by restricting sedative receptors in the gut divider, upgrading the resorption of water and electrolytes, diminishing propulsive peristalsis, improving intestinal travel time, decreasing gut emissions, and expanding butt-centric sphincter tone. The dose of loperamide is 4 mg at first, trailed by 2 mg after each free stool up to an all-out portion of 16mg/day.

Diphenoxylate

Diphenoxylate is a synthetic opioid. It is accessible as a co-phenotrope in combination with a subtherapeutic portion of atropine. Atropine is available to diminish the rate of illicit drug use. Yet at the same time, the organization of co-phenotrope at the suggested dose conveys the insignificant danger of dependence.

Morphine-type dependence is accounted for when utilized for a delayed timeframe at high portions. The initial dose of diphenoxylate/atropine for grown-ups is 5 mg (two pills), required three or four times each day. Then, at that point, the dose is typically decreased to 5 mg (two pills) when daily.

Antibiotics

Antibiotics are not generally shown for intrusive bacterial looseness of the bowels. For instance, non-typhoidal salmonella gastroenteritis in immunocompetent patients for the most part causes self-restricted loose bowels, and anti-toxins don't altogether abbreviate the course.

Antibiotics are endorsed for infants as long as a half year, more seasoned over 50 years, and people with a prosthesis, valvular coronary illness, extreme atherosclerosis, malignant growth, or uremia. Antibiotics might be chosen relying on stool culture.

Metronidazole is the drug of choice for the treatment of both amoebic dysentery and giardiasis. They are not indicated in the treatment of cryptosporidiosis in immunocompromised individuals. The use of TMP/SMX is limited because of resistance.

Zinc

Zinc supplementation (20 mg per day for 10 days in children older than two months) may play a crucial role in treating and preventing acute diarrhea.

Probiotics

Probiotics are thought to work by stimulating the immune system and acting against pathogens by competing for binding sites on intestinal epithelial cells. They are very effective for children with diarrhea. Well-known probiotics include lactic acid bacteria and the yeast Saccharomyces.

Absorbents

Ispaghula Husk and Attapulgite are effective as absorbents in mild to moderate diarrhea.

Vaccination

The Rotavirus vaccine has been shown to protect against the most common strains of rotavirus (G1 and G3).

Oral Rehydration Therapy and IV Fluids

The equation suggested by the World Health Organization (WHO) contains glucose, sodium, potassium, chloride, and bicarbonate in a practically isotonic liquid. In grown-ups, 2 L of oral rehydration liquid ought to be given in the initial 24 h, trailed by unhindered ordinary liquids with 200 mL of rehydration arrangement per free stool or regurgitation. For youngsters, 30–50 mL/kg of an ORS ought to be given more than 3–4 h. Then, at that point 10ml/kg of ORS per free stool or regurgitation.

Intravenous Rehydration Therapy (ICE)

Intravenous therapy might be required if there is a diminished degree of consciousness or if dehydration is severe. Commonly used intravenous rehydration solutions are ringer lactate infusion, ringer lactate infusion with 5% dextrose, 5% dextrose with electrolytes, dextrose + sodium chloride, and normal saline 0.9%.

Prevention Of Diarrhea

The following measures are effective for the prevention of diarrhea,

• Access to safe drinking water
• Handwashing with cleanser and germicides.
• Exclusive breastfeeding for the initial half-year of life.
• Eat clean food.
• Health schooling about how diseases spread.
• Rotavirus immunization.
• Poultry, meat, or shellfish are completely cooked.
• Take additional consideration to wash all foods grown from the ground and try not to eat crude shellfish. Cutting sheets and utensils ought to likewise be cleaned following coming into contact with crude meat, poultry, or fish.
• Finally, if traveling abroad, get yourself vaccinated.

FAQs About Diarrhea

What is diarrhea?

Diarrhea is a digestive condition characterized by frequent, loose, and watery bowel movements.

What are the common causes of diarrhea?

Diarrhea can be caused by several factors, including viral, bacterial, or parasitic infections, food poisoning, dietary choices, prescription side effects, or underlying medical conditions.

Is diarrhea a symptom of COVID-19?

Diarrhea can be a symptom of COVID-19, among other symptoms like fever, cough, and loss of taste or smell. If you suspect you have COVID-19, follow the guidance of healthcare authorities.

Is diarrhea contagious?

In rare cases, infectious agents such as viruses and bacteria can cause diarrhea, making it contagious. Good hygiene, such as frequent handwashing, can aid in the prevention of diarrhea that is contagious.

What should I eat when I have diarrhea?

It's advisable to stick to a bland diet with foods like rice, bananas, applesauce, and toast (BRAT diet). Avoid dairy, spicy, and fatty foods, as they can aggravate diarrhea.

How can I prevent diarrhea?

Practicing good hygiene, including frequent handwashing, consuming clean and safe food and water, and getting vaccinations when available (e.g., for rotavirus), can help prevent diarrhea. Avoiding known food triggers or allergens is also important.

How is diarrhea different from gastroenteritis?

One of the most common symptoms of gastroenteritis is diarrhea. Gastroenteritis is a medical term that refers to the inflammation of the stomach and intestines, primarily the gastrointestinal tract. It is a common condition characterized by symptoms such as diarrhea, vomiting, abdominal pain, and sometimes fever. Gastroenteritis is typically caused by viral or bacterial infections, ingestion of contaminated food or water, or exposure to other infectious agents. It can result in a range of gastrointestinal symptoms and is often referred to as "stomach flu" or "stomach bug." The condition is usually self-limiting and resolves with rest, hydration, and, in some cases, medication to manage symptoms.

Can stress or anxiety cause diarrhea?

Yes, stress and anxiety can affect bowel habits and may lead to diarrhea or other digestive symptoms in some individuals. Controlling your stress can assist with these symptoms.

What is chronic diarrhea?

Diarrhea that lasts more than four weeks is referred to as chronic diarrhea. Underlying medical diseases such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or malabsorption disorders may be to blame.

Is over-the-counter (OTC) medication safe for treating diarrhea?

Short-term usage of over-the-counter antidiarrheal drugs such as loperamide (Imodium) can be safe. They are not, however, appropriate for all types of diarrhea, and it is critical to follow dose directions and visit a healthcare practitioner if symptoms continue or worsen.

When should I see a doctor for diarrhea?

You should consult a healthcare provider if diarrhea persists for more than a couple of days, is accompanied by severe dehydration, bloody stools, high fever, or if you have underlying health conditions.

How is diarrhea treated?

Treatment depends on the underlying cause. For infectious diarrhea, rehydration and sometimes antidiarrheal medications may be recommended. Chronic diarrhea may require addressing the specific underlying condition.