非感染性慢性腹泻

慢性腹泻是临床常见的症状。引起腹泻的原因很多,大约75%的慢性腹泻患者可以通过病史、体格检查、筛查实验及有针对性的实验室检查明确诊断。另外,25%的患者诊断较为困难,须住院,以行全面检查。腹泻指排便次数增多(>3/d),粪便量增加(>200g/d),粪质稀薄(含水量>85%)。腹泻超过4周,即为     

急慢性腹泻患者肠道菌群的改变

目的探讨急慢性腹泻患者肠道菌群的变化及其差异。方法对20例慢性腹泻、31例急性腹泻及20例对照组的粪便进行肠杆菌、肠球菌、双歧杆菌、乳酸杆菌及类杆菌的培养及检测分析。结果与对照组比较,急性腹泻患者肠杆菌增加,肠球菌、双歧杆菌、乳酸杆菌及类杆菌减少(P<0.01),慢性腹泻患者肠杆菌增加,乳酸杆菌减少(P<0.05)。急性腹泻与慢性腹泻比较,类杆菌和乳酸杆菌减少更明显(P<0.05)。结论急慢性腹泻患者均存在肠道菌群失调,其中急性腹泻更严重。     

小儿腹泻病的治疗方法评估

腹泻是小儿的常见病.凡粪便性状改变,含水量增加(正常婴儿每日排便量>10g/kg、成人>200g)即可诊断患有腹泻病.除母乳哺养儿粪便常呈糊状外,正常粪便应该是成形的.由于小儿腹泻病常见,故治疗方法也多.应以有效、经济、无并发症和后遗症发生为评估标准.小儿腹泻病病因复杂,必须尽可能明确病因和病原,然临床实施较多困难,至少可以根据病史、体征和粪便性况将之分为有或无水、盐代谢紊乱的水样便性腹泻病和脓血便性腹泻病,首先纠正脱水、缺钠和酸中毒.对无并发症的水样便性腹泻病只需调整饮食(乳类哺养儿改用无乳糖奶粉)、保护肠道粘膜等措施就可使大多患儿治愈.对脓血便性腹泻病应区别为侵袭性细菌感染(最多见)、寄生虫性感染或炎症性(如溃疡性结肠炎等、多见于较大儿童、常呈慢性),予以区别处理.一切新治疗的评估,应通过足够病例数的双盲、空白对照的临床观察予以验证.     

急性腹泻患者粪便诺如病毒抗原检测及临床分析

目的探讨诺如病毒性腹泻患者的临床特点,了解粪便诺如病毒抗原检测在临床诊疗中的意义。方法2007年10月～2008年2月就诊于首都医科大学附属北京友谊医院肠道门诊的297例腹泻患者,留取粪便,采用ELISA检测诺如病毒抗原,并进行临床分析。结果297例腹泻患者,ELISA检测粪便,诺如病毒抗原阳性100例,阳性率为33.7%。结论诺如病毒感染是引起腹泻的重要原因之一,粪便诺如病毒ELISA检测为临床诊断该病提供了依据。     

对感染性腹泻的新认识

感染性腹泻是由多种病原体感染引起的，以排便次数增多、排便量增加和排出物性状改变为特征的一种症状。依据感染病原体的不同和机体的免疫功能状态，可伴有恶心、呕吐、腹痛、里急后重等，严重者可有发热和脱水等临床表现，腹泻物的性状也可有水样便、血便、脓液便、洗米水样便、洗肉水样便等。完整的腹泻的概念是：每日排便3次或3次以上，总量至少200g。连续腹泻不超过14d为急性腹泻，14～30d为持续腹泻，超过一个月为慢性腹泻。感染性腹泻持续时间与感染病原体的种类性质和预后有关。     

几种慢性腹泻的诊治体会

反复腹泻超过2个月者为慢性腹泻。此病病因复杂,有时给诊断与治疗带来困难。为此,本文介绍几种常见慢性腹泻的诊治体会。     

气郁体质腹泻型肠易激综合征患者实施辩证施护干预的效果观察

目的探讨辩证施护干预对气郁体质腹泻型肠易激综合征患者的临床效果。方法选取120例气郁体质腹泻型肠易激综合征患者为研究对象,根据其入院顺序分成常规护理组(对照组)和辩证施护组(观察组)。比较两组患者实施相关护理干预后临床效果差异,记录其Bristol粪便性状分级改善情况。结果(1)干预后,观察组疗效等级及总有效率优于观察组,差异有统计学意义(P0.05);(2)干预后,粪便性状分级中,观察组4级者36例,5级者19例,6级者5例,无7级者,对照组4级者19例,5级者30例,6级者10例,7级者1例,观察组粪便性状优于对照组,差异有统计学意义(P0.05)。结论对气郁体质的腹泻型肠易激综合征患者予以辩证施护干预措施,可有效改善其临床症状,值得推广应用。     

艾滋病慢性腹泻的中西医临床研究现状

艾滋病相关慢性腹泻是艾滋病病毒（HIV）感染者和病人的常见机会性感染之一,其诊断和治疗一直是艾滋病研究领域的热点和难点。该文收集了近年来艾滋病相关慢性腹泻研究的相关信息,从病因、流行病学、诊断和治疗等方面,对艾滋病相关慢性腹泻的中医和西医的研究近况进行综述。     

阴虚型慢性腹泻治验6例

慢性腹泻是指排便次数增多（＞3次/d）,粪便量增加（＞200 g/d）,粪质稀薄（含水量＞85％）,病程超过4周或反复发作.中医一般诊断为泄泻,多从寒湿、湿热、伤食、脾虚、肾虚、肝郁等证型论治,而以阴虚型进行论治较为少见.现将阴虚型慢性腹泻治验6例经验报告如下.关键词：慢性腹泻;阴虚型;痛泻要方分类号：R735.2 文献标识码：D文章编号：1671-038X（2013）11-0604-02     

粪钙卫蛋白测定判断感染性腹泻的临床价值

目的探讨粪便钙卫蛋白（FCP）在腹泻鉴别诊断中的临床应用价值。方法感染性腹泻48例、腹泻型肠易激综合征（D-IBS）30例及正常对照组30例分别留取粪便5~10 g,用ELISA法检测粪便钙卫蛋白含量;同时收集患者病史及临床资料。结果感染性腹泻病人粪便钙卫蛋白检测值（515.21μg/g,n=48）显著高于D-IBS组（35.02μg/g,n=30）和正常对照组（25.18μg/g,n=30）（P〈0.001）。D-IBS组和正常对照组之间无明显差异（P〉0.05）。感染性腹泻FCP检测值与粪便显微镜下白细胞个数呈正相关（r=0.761）。设定FCP值100μg/g为临界值时判断感染性腹泻的检测敏感性为85.4%特异性为90.0%准确性为87.2%。结论 FCP有望用于感染性腹泻和非感染性腹泻的初步鉴别,具有快速、简便、准确率高、患者依从性好等优点,值得临床推广应用。     

儿童慢性腹泻合并肠道蛋白丢失的临床研究

目的探讨儿童慢性腹泻合并肠道蛋白丢失的临床特点及病理特征。方法选取成都市第五人民医院儿科2010年10月-2012年12月诊治的慢性腹泻合并肠道蛋白丢失患儿31例为观察组,选取同期健康体检儿童31例为对照组,均行临床指征检测(总蛋白、白蛋白、前白蛋白、大便总量、当日血清α1-抗胰蛋白酶浓度、混匀后大便α1-抗胰蛋白酶浓度、24 h大便α1-抗胰蛋白酶清除率),分析观察组患儿的肠镜特点和病理特征。结果观察组患儿的总蛋白、白蛋白、前白蛋白、当日血清α1-抗胰蛋白酶浓度均明显低于对照组,观察组患儿的大便总α1-抗胰量、混匀后大便α1-抗胰蛋白酶浓度、24 h大便α1-抗胰蛋白酶清除率均明显高于对照组,差异均有统计学意义(P0.05)。克罗恩病、溃疡性结肠炎、嗜酸性胃肠病、过敏性胃肠病、肠结核均是儿童慢性腹泻合并肠道蛋白丢失的常见病症,均具有典型的病理特征。结论慢性腹泻合并肠道蛋白丢失患儿多伴有总蛋白、白蛋白、前白蛋白、大便总量、α1-抗胰蛋白酶等指标的异常改变,肠镜检查和病理检查是儿童慢性腹泻合并肠道蛋白丢失的有效检测手段。     

A practical approach to treating patients with chronic diarrhea

Although diarrhea is a common complaint, its evaluation and treatment can be challenging. Appropriately defining and classifying diarrhea provide the framework for approaching diagnostic and therapeutic options. Diarrhea can be defined based on frequency, consistency, and/or weight, and classified as acute or chronic with specific clinical characteristics and stool appearance. Colonoscopy is the most common diagnostic tool used in the evaluation of patients with chronic diarrhea. Other evaluation strategies include timed stool collections, evaluation of inflammatory markers, and hydrogen breath tests. A focused workup of chronic diarrhea may yield a specific diagnosis, including diarrhea-predominant IBS (dIBS), functional diarrhea, diabetic diarrhea, bile acid-induced diarrhea, and microscopic colitis. Ideally, therapeutic decisions are specifically tailored to target the underlying pathophysiology, including, for example, gluten restriction for celiac disease, rotating antibiotics for small bowel bacterial overgrowth, budesonide therapy for collagenous colitis, and loperamide for treatment of functional diarrhea. It is also important to assess the role of diet and medications in chronic diarrhea. However, if no specific causes are identified following workup, empiric therapy with simple opiate antidiarrheals such as loperamide may be effective. If this proves unsuccessful, the use of more potent agents, including codeine and opium, may be considered.     

慢性胰腺炎213例的临床特点

目的:回顾性分析9 a间慢性胰腺炎(CP)的临床特点．方法:对住院诊断CP 213例,按发病情况、临床表现、诊断方法及漏误诊等特点进行统计．结果:CP213例,占消化科住院患者的4．38％, 男女之比1:0．84,9 a间每3 a发病增长为 38．6％,病因:胆源性36．2％,酒精性42．7％,高血脂13．6％,原因不明7．5％;临床表现:持续腹痛仅9．9％,进食后腹痛44％,两者相加为 53．5％,而慢性腹泻或脂肪泻占57％,进高脂肪餐(包括饮酒)后腹胀或腹泻81％,吸收不良 41％,糖尿病7．0％;在诊断方面:72．3％是以临床表现、大便脂肪定性或胰腺外分泌功能试验及CT、EUS影象学特征诊断,27．7％超声内镜引导下细针穿插通过病理诊断,在漏误诊方面:33．8％长期诊断为慢性胃炎或萎缩性胃炎,30．5％诊断为慢性腹泻、肠炎或慢性结肠炎,11．3％诊断为胆系结石或胆囊术后综合症, 3．8％诊断为胰腺新生物或胰腺癌．结论:CP发病率在上升,临床表现腹痛不突出,而且多样性,应早期诊断,避免漏诊和误诊     

Gastro 2013 APDW/WCOG Shanghai Working Party Report: Chronic diarrhea: Definition,classification, diagnosis

Diarrhea is best defined as passage of loose stools often with more frequent bowel movements. For clinical purposes, the Bristol Stool Form Scale works well to distinguish stool form and to identify loose stools. Laboratory testing of stool consistency has lagged behind. Acute diarrhea is likely to be due to infection and to be self‐limited. As diarrhea becomes chronic, it is less likely to be due to infection; duration of 1 month seems to work well as a cut‐off for chronic diarrhea, but detailed scientific knowledge is missing about the utility of this definition. In addition to duration of diarrhea, classifications by presenting scenario, by pathophysiology, and by stool characteristics (e.g. watery, fatty, or inflammatory) may help the canny clinician refine the differential diagnosis of chronic diarrhea. In this regard, a careful history remains the essential part of the evaluation of a patient with diarrhea. Imaging the intestine with endoscopy and radiographic techniques is useful, and biopsy of the small intestine and colon for histological assessment provides key diagnostic information. Endomicroscopy and molecular pathology are only now being explored for the diagnosis of chronic diarrhea. Interest in the microbiome of the gut is increasing; aside from a handful of well‐described infections because of pathogens, little is known about alterations in the microbiome in chronic diarrhea. Serological tests have well‐defined roles in the diagnosis of celiac disease but have less clearly defined application in autoimmune enteropathies and inflammatory bowel disease. Measurement of peptide hormones is of value in the diagnosis and management of endocrine tumors causing diarrhea, but these are so rare that these tests are of little value in screening because there will be many more false‐positives than true‐positive results. Chemical analysis of stools is of use in classifying chronic diarrhea and may limit the differential diagnosis that must be considered, but interpretation of the results is still evolving. Breath tests for assessment of carbohydrate malabsorption, small bowel bacterial overgrowth, and intestinal transit are fraught with technical limitations that decrease sensitivity and specificity. Likewise, tests of bile acid malabsorption have had limited utility beyond empirical trials of bile acid sequestrants.     

Chronic diarrhea with uncommon etiology

Chronic diarrhea is a common syndrome. An etiological diagnosis is often reached through clinical history, physical examination and simple tests. In some cases, when the etiology is not found, the syndrome is called functional diarrhea, even though established criteria are often not fulfilled. We present the case of a patient with diarrhea for several months. The most common causes were ruled out through clinical history, physical examination, radiographic studies and laboratory tests, and the patient was diagnosed with functional diarrhea. Three months later, the patient presented a neck mass, and biopsy revealed medullary carcinoma of the thyroid. A review of recommendations for the systematic evaluation of chronic diarrhea is presented. A general approach should include careful history taking characteristics of diarrhea (onset, associated symptoms, epidemiological factors, iatrogenic causes such as laxative ingestion), a thorough physical examination with special attention to the anorectal region, and routine laboratory tests (complete blood count and serum chemistry). In addition, stool analysis including electrolytes (fecal osmotic gap), leukocytes, fecal occult blood, excess stool fat and laxative screening can yield important objective information to classify the diarrhea as: osmotic (osmotic gaps > 125 mOsm/Kg), secretory (osmotic gaps < 50 mOsm/Kg), inflammatory or steatorrheic. At this point in the evaluation, a specific diagnosis may be made. However, if diagnosis is not reached further specific examinations should be performed for each of the 4 types of diarrhea described above. A systematic approach to the evaluation of chronic diarrhea is warranted. Medullary thyroid carcinoma and other endocrine syndromes causing chronic diarrhea are very rare. Measurement of serum peptide concentrations should only be performed when clinical presentation and findings in stool or radiographic studies suggest this etiology.     

Clinical approach to diarrhea

Diarrhea is defined as reduced stool consistency, increased water content and number of evacuations per day. A wide array of causes and pathophysiological mechanisms underlie acute and chronic forms of diarrhea. This review focuses on the major clinical aspects which should aid clinicians to diagnose chronic diarrhea. Clinical history, physical examination and stool evaluation and the predominant stool characteristic, i.e., bloody, watery, and fatty diarrhea, may narrow the differential diagnosis. Although mainly involved in acute diarrhea, many different infectious agents, including bacteria, viruses and protozoa, can be identified in chronic bloody/inflammatory diarrhea by appropriate microbiological tests and colonoscopic biopsy analysis. Osmotic diarrhea can be the result of malabsorption or maldigestion, with a subsequent passage of fat in the stool leading to steatorrhea. Secretory diarrhea is due to an increase of fluid secretion in the small bowel lumen, a mechanism often identified in gastroenteropancreatic neuroendocrine tumors. The evaluation of the fecal osmotic gap may help to characterize whether a chronic diarrhea is osmotic or secretory. Fatty diarrhea (steatorrhea) occurs if fecal fat output exceeds the absorptive/digestive capacity of the intestine. Steatorrhea results from malabsorption or maldigestion states and tests should differentiate between these two conditions. Individualized diagnostic work ups tailored on pathophysiological and clinical features are expected to reduce costs for patients with chronic diarrhea.     

细菌感染性腹泻2380例临床及病原学分析

目的 了解细菌感染性腹泻的临床及病原学特点.方法 回顾性分析1998年至2007年复大学附属金山医院感染性腹泻患者2380例的临床及细菌学特点.计数资料行X~2检验.结果 10年间因腹泻就诊的20 169例患者中,2380例粪细菌培养阳性,包括副溶血弧菌感染2247例,占94.4%,志贺菌属感染99例,占4.2%,沙门菌属感染29例,占1.2%,溶藻弧菌感染3例,致病性大肠埃希菌感染2例.因腹泻就诊者在每年6至10月多见,副溶血弧菌感染主要表现为腹痛、腹泻、恶心、呕吐,可伴有脱水,志贺菌属感染主要表现为发热、腹痛、腹泻.结论 上海市金山区细菌感染性腹泻患者粪细菌培养阳性率不高,仍以副溶血弧菌、志贺菌属为主要致病菌.     

Profile of chronic small-bowel diarrhea in adults in Western India: a hospital-based study.

BACKGROUND: Small-bowel diarrhea is reported to account for 10% of all cases of chronic diarrhea. Data on the etiology and clinical presentation of chronic small-bowel diarrhea in adult Indians is scarce. METHODS: 50 patients (mean age 32.8 years; 26 men) with chronic small bowel diarrhea were evaluated clinically, and investigated to determine etiology. The diagnosis of small-bowel diarrhea was based on history, stool volume and associated symptoms. RESULTS: Abdominal pain (n=22, 44%) and weight loss (n=37, 74%) were the most common symptoms, apart from diarrhea. Anemia (70%) and hypoalbuminemia (48%) were other important biochemical abnormalities. Intestinal tuberculosis (26%) and celiac disease (26%) were the most common causes of chronic small-bowel diarrhea. CONCLUSION: Tuberculosis of intestine and celiac disease are common causes of small-bowel diarrhea in our population. Tropical sprue seems to be a rare cause.     

参苓白术散治疗慢性腹泻效果的Meta分析

目的评价参苓白术散对慢性腹泻的治疗效果。方法计算机检索中国知网、维普、万方、Pubmed等数据库中关于参苓白术散对慢性腹泻的影响的随机对照试验(RCT),同时筛检纳入文献的参考文献。由3名研究者对文献质量进行严格评价及资料提取,对符合质量标准的RCT进行Meta分析。结果参苓白术散治疗慢性腹泻较常规西药更能有效减少大便量及大便次数,改善大便性状。结论参苓白术散治疗慢性腹泻效果优于常规西药。     

Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas

OBJECTIVE: Upper endoscopy has been suggested as a valuable tool in the diagnosis of giardiasis. The aim of this study was to compare two methods based on endoscopy, i.e. microscopy of duodenal fluid and histology, with a fluorescent-antibody assay for the detection of Giardia lamblia cysts in stool specimens. The role of endoscopy in the identification of other causes of chronic diarrhea acquired during travel abroad was also evaluated. MATERIAL AND METHODS: Thirty-one patients (9 F, 22 M, median age 39 years, range 19-63 years) with persistent diarrhea after returning from tropical or subtropical areas agreed to undergo upper gastrointestinal endoscopy before and after treatment. Lower gastrointestinal endoscopy was subsequently performed. Three stool samples from each patient were examined using the direct fluorescent-antibody assay (DFA) for the detection of G. lamblia, and by routine methods for other protozoal and bacterial enteric pathogens. Each patient underwent upper endoscopy and biopsies and duodenal fluid samples were taken. In 12 patients a further lower endoscopy was performed. RESULTS: In 16 patients G. lamblia was detected in stool samples by DFA (relative sensitivity: 100%). Histology of duodenal biopsies and microscopy of duodenal fluids allowed diagnosis of giardiasis to be made in only 8, and 3 patients, respectively (relative sensitivities: 21% and 44%). Besides giardiasis, upper endoscopic examination revealed an alternative diagnosis (tropical sprue), whereas six additional diagnoses were made by colonoscopy. In six patients the cause of chronic diarrhea remained unclear. CONCLUSIONS: Compared to stool examinations using DFA, upper endoscopy is less sensitive for the diagnosis of giardiasis. In patients with negative stool examinations, lower endoscopy yields relevant diagnoses more often than upper endoscopy.