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Diarrhea

For other uses, see Diarrhea (disambiguation).

Diarrhea
Other namesDiarrhoea (or diarrhœa)
An electron micrograph of rotavirus, the cause of nearly 40% of hospitalizations from diarrhea in children under five[1]
SpecialtyInfectious disease, gastroenterology
SymptomsLoose frequent bowel movements, dehydration[2]
CausesUsually infection (viral, bacterial, parasitic)[2]
Risk factorsContaminated food or water[2]
PreventionHandwashing, rotavirus vaccination, breastfeeding[2]
TreatmentOral rehydration solution, zinc supplementation[2]
Frequency≈2.4 billion (2015)[3]
Deaths1.53 million (2019)[4]

Diarrhea (American English), also spelled diarrhoea or diarrhœa (British English), is the condition of having at least three loose, liquid, or watery bowel movements in a day.[2] It often lasts for a few days and can result in dehydration due to fluid loss.[2] Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour.[2] This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe.[2] Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.[2]

What is diarrhea, how is it caused, treated and prevented (see also script).
Bristol stool scale

The most common cause is an infection of the intestines due to a virus, bacterium, or parasite—a condition also known as gastroenteritis.[2] These infections are often acquired from food or water that has been contaminated by feces, or directly from another person who is infected.[2] The three types of diarrhea are: short duration watery diarrhea, short duration bloody diarrhea, and persistent diarrhea (lasting more than two weeks, which can be either watery or bloody).[2] The short duration watery diarrhea may be due to cholera, although this is rare in the developed world.[2] If blood is present, it is also known as dysentery.[2] A number of non-infectious causes can result in diarrhea.[5] These include lactose intolerance, irritable bowel syndrome, non-celiac gluten sensitivity, celiac disease, inflammatory bowel disease such as ulcerative colitis, hyperthyroidism, bile acid diarrhea, and a number of medications.[5][6][7] In most cases, stool cultures to confirm the exact cause are not required.[8]

Diarrhea can be prevented by improved sanitation, clean drinking water, and hand washing with soap.[2] Breastfeeding for at least six months and vaccination against rotavirus is also recommended.[2] Oral rehydration solution (ORS)—clean water with modest amounts of salts and sugar—is the treatment of choice.[2] Zinc tablets are also recommended.[2] These treatments have been estimated to have saved 50 million children in the past 25 years.[1] When people have diarrhea it is recommended that they continue to eat healthy food, and babies continue to be breastfed.[2] If commercial ORS is not available, homemade solutions may be used.[9] In those with severe dehydration, intravenous fluids may be required.[2] Most cases, however, can be managed well with fluids by mouth.[10] Antibiotics, while rarely used, may be recommended in a few cases such as those who have bloody diarrhea and a high fever, those with severe diarrhea following travelling, and those who grow specific bacteria or parasites in their stool.[8] Loperamide may help decrease the number of bowel movements but is not recommended in those with severe disease.[8]

About 1.7 to 5 billion cases of diarrhea occur per year.[2][5][11] It is most common in developing countries, where young children get diarrhea on average three times a year.[2] Total deaths from diarrhea are estimated at 1.53 million in 2019—down from 2.9 million in 1990.[4] In 2012, it was the second most common cause of deaths in children younger than five (0.76 million or 11%).[2][12] Frequent episodes of diarrhea are also a common cause of malnutrition and the most common cause in those younger than five years of age.[2] Other long term problems that can result include stunted growth and poor intellectual development.[12]

  1. ^ a b "whqlibdoc.who.int" (PDF). World Health Organization. Archived (PDF) from the original on 8 November 2010.
  2. ^ a b c d e f g h i j k l m n o p q r s t u v w x y "Diarrhoeal disease Factsheet". World Health Organization. 2 May 2017. Archived from the original on 11 November 2020. Retrieved 29 October 2020.
  3. ^ Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators) (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  4. ^ a b Dadonaite B, Ritchie H, Roser M (1 November 2018). "Diarrheal diseases". Our World in Data. Archived from the original on 19 June 2022. Retrieved 28 April 2022.
  5. ^ a b c Abdelmalak B, Doyle J, eds. (2013). Anesthesia for otolaryngologic surgery. Cambridge University Press. pp. 282–287. ISBN 978-1-107-01867-9.
  6. ^ Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M, et al. (February 2012). "Spectrum of gluten-related disorders: consensus on new nomenclature and classification". BMC Medicine (Review). 10: 13. doi:10.1186/1741-7015-10-13. PMC 3292448. PMID 22313950. Open access icon
  7. ^ Slattery SA, Niaz O, Aziz Q, Ford AC, Farmer AD (July 2015). "Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea" (PDF). Alimentary Pharmacology & Therapeutics. 42 (1): 3–11. doi:10.1111/apt.13227. PMID 25913530. S2CID 34603226. Archived (PDF) from the original on 9 May 2020. Retrieved 23 September 2019.
  8. ^ a b c DuPont HL (April 2014). "Acute infectious diarrhea in immunocompetent adults". The New England Journal of Medicine. 370 (16): 1532–40. doi:10.1056/nejmra1301069. PMID 24738670.
  9. ^ Crockett ME, Keystone JS (2012). "Protection of Travelers". In Fischer M, Long SS, Prober CG (eds.). Principles and practice of pediatric infectious diseases (4th ed.). Edinburgh: Elsevier Saunders. p. 82. ISBN 978-1-4557-3985-1.
  10. ^ ACEP (14 October 2013). "Nation's Emergency Physicians Announce List of Test and Procedures to Question as Part of Choosing Wisely Campaign". Choosing Wisely. Archived from the original on 17 May 2014. Retrieved 18 June 2014.
  11. ^ Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, et al. (Global Burden of Disease Study 2013 Collaborators) (August 2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 386 (9995): 743–800. doi:10.1016/s0140-6736(15)60692-4. PMC 4561509. PMID 26063472.
  12. ^ a b "Global Diarrhea Burden". CDC. 24 January 2013. Archived from the original on 7 July 2014. Retrieved 18 June 2014.

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