Acute diarrhea differential diagnosis

https://www.wikidoc.org/index.php/Acute_diarrhea_overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Sadaf Sharfaei M.D.[2], Seyedmahdi Pahlavani, M.D. [3]

## Overview

[edit | edit source]

The differentials of acute diarrhea include Ischemic colitis, Lactose intolerance, Tropical sprue, Pseudomembranous enterocolitis, Campylobacteriosis, Salmonellosis, Shigellosis, Escherichia coli enteritis, Yersinia enterocolitica, Vibrio cholera, Aeromonas, Plesiomonas, Staphylococcus aureus, Bacillus cereus, Clostridium perfringens, Rotavirus, Norovirus, Adenovirus, Entamoeba histolytica, medications, Short bowel syndrome, Organophosphate poisoning, Radiation enteritis and Opium withdrawal.

## Differential Diagnosis of Acute Diarrhea from other diseases

[edit | edit source]

To review the differential diagnosis of diarrhea, click here.

To review the differential diagnosis of traveler's diarrhea, click here.

To review the differential diagnosis of acute watery diarrhea, click here.

To review the differential diagnosis of acute bloody diarrhea, click here.

To review the differential diagnosis of acute fatty diarrhea, click here.

To review the differential diagnosis of acute diarrhea and fever, click here.

To review the differential diagnosis of acute diarrhea and abdominal pain, click here.

To review the differential diagnosis of acute diarrhea and weight loss, click here.

To review the differential diagnosis of acute diarrhea, fever, and abdominal pain, click here.

To review the differential diagnosis of acute diarrhea, abdominal pain, and weight loss, click here. The following table outlines the major differential diagnoses of acute diarrhea.[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]

Abbreviations: GI: Gastrointestinal, CBC: Complete blood count, WBC: White blood cell, RBC: Red blood cell, Plt: Platelet, Hgb: Hemoglobin, ESR: Erythrocyte sedimentation rate, CRP: C–reactive protein, IgE: Immunoglobulin E, IgA: Immunoglobulin A, ETEC: Escherichia coli enteritis, EPEC: Enteropathogenic Escherichia coli, EIEC: Enteroinvasive Escherichia coli, EHEC: Enterohemorrhagic Escherichia coli, EAEC: Enteroaggregative Escherichia coli, Nl: Normal, ASCA: Anti saccharomyces cerevisiae antibodies, ANCA: Anti–neutrophil cytoplasmic antibody, DNA: Deoxyribonucleic acid, CFTR: Cystic fibrosis transmembrane conductance regulator, SLC10A2: Solute carrier family 10 member 2, SeHCAT: Selenium homocholic acid taurine or tauroselcholic acid, IEL: Intraepithelial lymphocytes, MRCP: Magnetic resonance cholangiopancreatography, ANA: Antinuclear antibodies, AMA: Anti-mitochondrial antibody, LDH: Lactate dehydrogenase, CPK: Creatine phosphokinase, PCR: Polymerase chain reaction, ELISA: Enzyme–linked immunosorbent assay, LT: Heat–labile enterotoxin, ST: Heat–stable enterotoxin, RT-PCR: Reverse–transcriptase polymerase chain reaction, CD4: Cluster of differentiation 4, HIV: Human immunodeficiency virus, RUQ: Right-upper quadrant, VIP: Vasoactive intestinal peptide, GI: Gastrointestinal, FAP: Familial adenomatous polyposis, HNPCC: Hereditary nonpolyposis colorectal cancer, MTP: Microsomal triglyceride transfer protein, Scl‑70: Anti–topoisomerase I, TSH: Thyroid-stimulating hormone, T4: Thyroxine, T3: Triiodothyronine, DTR: Deep tendon reflex, RNA: Ribonucleic acid

Cause  | Clinical manifestation | Lab findings | Extra intestinal findings  | Cause/Pathogenesis  | Gold standard diagnosis

|
|
|
|
|

Symptoms  | GI signs
Duration  | Diarrhea  | Fever  | Abdominal pain  | Weight loss
Stool exam  | CBC | Other lab findings
Acute  | Chronic  | Watery  | Bloody  | Fatty  | WBC  | RBC  | Ova/Parasite  | Osmotic gap  | Other  | WBC  | Hgb  | Plt
Ischemic colitis | \+  | \+  | \+  | \+  | –  | \+  | \+  | \+  |

* Hyperactive then absent bowel sounds
* Abdominal tenderness

| \+  | \+  | –  | Nl  | –  | ↑  | ↓  | ↑  |

* Elevated CRP
* Elevated ESR
* Elevated serum lactate
* Elevated lactate dehydrogenase (LDH)
* Elevated creatine phosphokinase (CPK)
* Elevated amylase
* Hypoalbuminemia

* IgA vasculitis

* Hypercoagulability
* Nonocclusive colonic ischemia
* Embolic and thrombotic arterial occlusion
* Mesenteric vein thrombosis

* Abdominal CT scan

Lactose intolerance | \+  | \+  | \+  | –  | –  | –  | \+  | –  |

* Abdominal tenderness
* Abdominal distention

| –  | –  | –  | ↑  | –  | Nl  | Nl  | Nl  |

* Lactose tolerance test
* Genetic testing

* Headache
* Vertigo
* Memory impairment
* Lethargy

* Reduction of lactase enzyme activity or inability to produce persistent lactase
* Congenital lactase deficiency
* Secondary lactose malabsorption

* Small bowel biopsy
* Lactose breath hydrogen test

Tropical sprue | \+  | \+  | \+  | –  | \+  | \+  | \+  | \+  |

* Angular stomatitis
* Oral mucosal lesion

| \+  | –  | –  | Nl  |

* Positive stool culture

| Nl  | ↓  | Nl  |

* Fat soluble vitamins deficiency
* Vitamin B12 deficiency
* Folate deficiency
* Hypokalemia

* Myalgia
* Neuropathy
* Edema

* Escherichia coli
* Klebsiella pneumoniae
* Enterobacter cloacae

* Diagnosis of exclusion

Cause  | Duration  | Diarrhea  | Fever  | Abdominal pain  | Weight loss  | GI signs  | Stool exam  | CBC  | Other lab findings  | Extra intestinal findings  | Cause/Pathogenesis  | Gold standard diagnosis
Acute  | Chronic  | Watery  | Bloody  | Fatty  | WBC  | RBC  | Ova/Parasite  | Osmotic gap  | Other  | WBC  | Hgb  | Plt
Pseudomembranous enterocolitis | \+  | –  | \+  | ±  | –  | \+  | \+  | ±  |

* Generalized abdominal tenderness
* Abdominal distention
* Rebound abdominal tenderness

| \+  | \+  | –  | Nl  |

* Enzyme–linked immunosorbent assay (ELISA)
* Polymerase chain reaction (PCR) assay or C. difficile antigen

| ↑  | ↓  | ↓  |

* Elevated serum creatinine
* Hypoalbuminemia
* Elevated lactic acid

* Dehydration
* Acute kidney injury

* Bacteremia
* Reactive arthritis
* Necrotizing fasciitis

* Clostridium difficile
* Recent antibiotics use
* Recent surgery

* Stool exam
* Pseudomembranes on colonoscopy

Campylobacteriosis | \+  | –  | \+  | \+  | –  | \+  | \+  | –  |

* Diffuse abdominal tenderness

| \+  | \+  | –  | Nl  |

* Positive stool culture

| ↑  | Nl  | Nl  | Nl  |

* Toxic megacolon
* Sepsis
* Arthritis
* Endocarditis
* Guillain–Barré syndrome

* Campylobacter jejuni

* Stool culture

Salmonellosis | \+  | \+  | \+  | \+  | –  | \+  | \+  | –  |

* Abdominal distention
* Diffuse abdominal tenderness
* Hepatosplenomegaly

| \+  | \+  | –  | Nl  |

* Positive stool culture
* Positive serologic testing

| ↑  | Nl  | ↑  |

* Hypokalemia
* Hypernatremia
* Hyponatremia
* Hypercalciuria
* Hypocitraturia

* Post–infectious arthritis
* Obtundation
* Bacteremia
* Pericarditis
* Pyelonephritis
* Brain abscess

* Salmonella

* Stool culture

Shigellosis | \+  | –  | \+  | \+  | –  | \+  | \+  | –  |

* Abdominal distention
* Hyperactive bowel sounds
* Diffuse abdominal tenderness

| \+  | \+  | –  | Nl  |

* Positive stool culture

| ↑/↓  | ↓  | ↓  |

* Elevated CRP
* Elevated ESR
* Hyponatremia
* Hypoglycemia
* Azotemia

* Headache
* Lethargy
* Seizures
* Delirium
* Post–infectious arthritis
* Myocarditis

* Shigella

* Stool culture

Cause  | Duration  | Diarrhea  | Fever  | Abdominal pain  | Weight loss  | GI signs  | Stool exam  | CBC  | Other lab findings  | Extra intestinal findings  | Cause/Pathogenesis  | Gold standard diagnosis
Acute  | Chronic  | Watery  | Bloody  | Fatty  | WBC  | RBC  | Ova/Parasite  | Osmotic gap  | Other  | WBC  | Hgb  | Plt
Escherichia coli enteritis | ETEC

(Traveler's diarrhea)

| \+  | –  | \+  | –  | –  | \+  | –  | –  |

* Diffuse abdominal tenderness

| \+  | –  | –  | Nl  |

* Positive stool culture

| ↑  | Nl  | Nl  | –  | –  |

* Enterotoxigenic escherichia coli
* Enterotoxins:
* Heat–labile enterotoxin (LT)
* Heat–stable enterotoxin (ST)

* Stool culture

EPEC | \+  | \+  | \+  | \+  | –  | \+  | \+  | \+  |

* Diffuse abdominal tenderness

| \+  | \+  | –  | Nl  |

* Positive stool culture

| ↑  | Nl  | Nl  | –  | –  |

* Enteropathogenic E. coli

* DNA probe or polymerase chain reaction (PCR) of the EPEC adherence factor
* Stool culture

EIEC | \+  | –  | \+  | \+  | –  | \+  | \+  | –  |

* Diffuse abdominal tenderness

| \+  | \+  | –  | Nl  |

* Positive stool culture

| ↑  | Nl  | Nl  | –  | –  |

* Enteroinvasive E. coli

* DNA probe
* Stool culture

EHEC | \+  | –  | \+  | \+  | –  | –  | \+  | –  |

* Diffuse abdominal tenderness

| \+  | \+  | –  | Nl  |

* Positive stool culture

| ↑  | ↓  | ↓  |

* Azotemia

* Hemolytic uremic syndrome (HUS)
* Renal failure

* Enterohemorrhagic E. coli
* Shiga toxins

* Stool culture

EAEC | \+  | \+  | \+  | \+  | –  | –  | \+  | –  |

* Diffuse abdominal tenderness

| \+  | \+  | –  | Nl  |

* Positive stool culture

| ↑  | ↓  | ↓  | –  |

* Chronic infection in immunocompromised patients

* Enteroaggregative E. coli

* Stool culture

Cause  | Duration  | Diarrhea  | Fever  | Abdominal pain  | Weight loss  | GI signs  | Stool exam  | CBC  | Other lab findings  | Extra intestinal findings  | Cause/Pathogenesis  | Gold standard diagnosis
Acute  | Chronic  | Watery  | Bloody  | Fatty  | WBC  | RBC  | Ova/Parasite  | Osmotic gap  | Other  | WBC  | Hgb  | Plt
Yersinia enterocolitica | \+  | –  | \+  | \+  | –  | \+  | \+  | –  |

* Abdominal distention
* Hyperactive bowel sounds
* Diffuse abdominal tenderness

| \+  | \+  | –  | Nl  |

* Positive stool culture

| ↑  | Nl  | Nl  | –  |

* Bacteremia
* Reactive arthritis
* Glomerulonephritis
* Endocarditis
* Erythema nodosum
* Abscess

* Yersinia enterocolitica

* Stool culture

Vibrio cholera | \+  | –  | \+  | –  | –  | –  | \+  | –  |  | \+  | –  | –  | Nl  |

* Positive stool culture

| ↑  | Nl  | Nl  |

* Azotemia

* Severe dehydration
* Decreased skin turgor
* Oliguria
* Renal failure
* Muscle cramps
* Seizure
* Somnolence

* Cholera toxin

* Stool culture

Aeromonas | \+  | \+  | \+  | \+  | –  | \+  | \+  | –  |

* Abdominal distention
* Hyperactive bowel sounds
* Diffuse abdominal tenderness

| \+  | \+  | –  | Nl  |

* Positive stool culture

| ↑  | Nl  | Nl  | –  |

* Wound infection
* Bacteremia
* Hemolytic uremic syndrome
* Meningitis
* Ocular infection
* Pneumonia
* Urinary tract infection
* Osteomyelitis
* Peritonitis
* Acute cholecystitis
* Opportunistic infections in immunocompromised patients

* Aeromonas virulence factors including endotoxins, hemolysins, enterotoxins, and adherence factors

* Blood culture
* Wound culture

Cause  | Duration  | Diarrhea  | Fever  | Abdominal pain  | Weight loss  | GI signs  | Stool exam  | CBC  | Other lab findings  | Extra intestinal findings  | Cause/Pathogenesis  | Gold standard diagnosis
Acute  | Chronic  | Watery  | Bloody  | Fatty  | WBC  | RBC  | Ova/Parasite  | Osmotic gap  | Other  | WBC  | Hgb  | Plt
Plesiomonas | \+  | –  | \+  | \+  | –  | \+  | \+  | –  |

* Hyperactive bowel sounds
* Diffuse abdominal tenderness

| \+  | \+  | –  | Nl  |

* Positive stool culture

| ↑  | Nl  | Nl  | –  |

* Opportunistic infections in immunocompromised patients or hepatobiliary disease
* Bacteremia
* Cellulitis and skin abscesses
* Peritonitis
* Meningoencephalitis
* Ocular infection
* Pneumonia
* Prosthetic joint infection
* Septic abortion

* Plesiomonas shigelloides

* Blood culture

Mycobacterium avium complex | \+  | \+  | \+  | \+  | –  | \+  | \+  | –  |

* Abdominal distention
* Hepatosplenomegaly

| \+  | \+  | –  | Nl  | –  | ↓  | ↓  | Nl  |

* Elevated liver enzymes

* Opportunistic infection in immunocompromised patients
* Pulmonary infection
* Adenopathy
* Night sweats

* Mycobacterium avium complex

* Blood culture

Food poisoning

* Staphylococcus aureus
* Bacillus cereus
* Clostridium perfringens

| \+  | –  | \+  | ±  | –  | \+  | \+  | ±  |

* Abdominal distention

| \+  | ±  | –  | Nl  |

* Positive stool culture

| ↑  | Nl  | Nl  | –  |

* History of travel or ingestion of infected food

* Enterotoxins

* Stool culture

Cause  | Duration  | Diarrhea  | Fever  | Abdominal pain  | Weight loss  | GI signs  | Stool exam  | CBC  | Other lab findings  | Extra intestinal findings  | Cause/Pathogenesis  | Gold standard diagnosis
Acute  | Chronic  | Watery  | Bloody  | Fatty  | WBC  | RBC  | Ova/Parasite  | Osmotic gap  | Other  | WBC  | Hgb  | Plt
Norovirus | \+  | –  | \+  | –  | –  | \+  | \+  | –  |

* Abdominal distention

| –  | –  | –  | Nl  |

* Positive stool reverse–transcriptase polymerase chain reaction (RT–PCR)

| ↓  | Nl  | Nl  | –  |

* Myalgia
* Headache
* Seizure
* Encephalopathy

* Norovirus

* Clinical diagnosis

Rotavirus | \+  | –  | \+  | –  | –  | \+  | –  | –  |

* Hyperactive bowel sounds
* Diffuse abdominal tenderness

| \+  | –  | –  | Nl  | –  | Nl  | Nl  | Nl  |

* Elevated blood urea nitrogen
* Hyperchloremic acidosis
* Hypocalcemia

* Necrotizing enterocolitis
* Intussusception
* Biliary atresia
* Central nervous system involvement

* Rotavirus

* Stool immune–based assays

Echovirus | \+  | –  | \+  | –  | –  | \+  | \+  | –  |

* Abdominal distention

| –  | –  | –  | Nl  | –  | Nl  | Nl  | Nl  | –  |

* Liver failure
* Myocarditis

* Echovirus

* Clinical diagnosis

Adenovirus | \+  | –  | \+  | –  | –  | \+  | \+  | –  |

* Abdominal distention

| –  | –  | –  | Nl  |

* Viral antigen assay

| Nl  | Nl  | Nl  | –  |

* Respiratory disease
* Follicular conjunctivitis
* Epidemic keratoconjunctivitis
* Hepatitis
* Urethritis
* Myocarditis
* Meningitis
* Bacteremia

* Adenovirus

* Clinical diagnosis

CMV colitis | \+  | \+  | –  | \+  | –  | ±  | \+  | –  |

* Diffuse abdominal tenderness

| \+  | \+  | –  | Nl  |

* Viral antigen assay

| ↓  | Nl  | Nl  |

* Decreased CD4 level
* Abnormal liver function test

* Encephalitis
* Guillain–Barré syndrome
* Pneumonia
* Retinitis
* Pericarditis and myocarditis
* Atherosclerosis
* Venous thrombosis

* Cytomegalovirus

* Quantitative PCR tests

Cause  | Duration  | Diarrhea  | Fever  | Abdominal pain  | Weight loss  | GI signs  | Stool exam  | CBC  | Other lab findings  | Extra intestinal findings  | Cause/Pathogenesis  | Gold standard diagnosis
Acute  | Chronic  | Watery  | Bloody  | Fatty  | WBC  | RBC  | Ova/Parasite  | Osmotic gap  | Other  | WBC  | Hgb  | Plt
Entamoeba histolytica | \+  | \+  | \+  | \+  | –  | \+  | \+  | –  |

* Abdominal distention
* Diffuse abdominal tenderness

| \+  | \+  | \+  | Nl  | –  | ↑  | Nl  | Nl  | –  |

* Liver abscess
* Pleuropulmonary infection
* Cardiac infection
* Brain abscess
* Cutaneous infection

* Entamoeba histolytica

* Antigen testing
* Serology

Microsporidia | \+  | \+  | \+  | –  | –  | \+  | \+  | –  |

* Abdominal distention
* Diffuse abdominal tenderness

| –  | –  | \+  | Nl  |

* Positive stool microscopy

| Nl  | Nl  | Nl  |

* Decreased CD4 count

* Malabsorption
* Keratitis
* Seizure
* Myositis

* Microsporidia

* Antigen detection assays

Isospora | \+  | \+  | \+  | –  | \+  | \+  | \+  | \+  |

* Abdominal distention
* Diffuse abdominal tenderness

| \+  | \+  | \+  | Nl  |

* Positive stool microscopy
* Positive fecal fat

| ↑  | Nl  | Nl  |

* Elevated eosinophils
* Hypokalemia
* Increased creatinine

* Chronic illness in immunocompromised patients

* Isospora

* Detecting oocysts in the feces

VIPoma | \+  | \+  | \+  | –  | \+  | –  | \+  | \+  |

* Abdominal distention
* Abdominal RUQ tenderness
* Nausea
* Vomiting

| –  | –  | –  | ↓  | –  | Nl  | Nl  | Nl  |

* Elevated VIP level
* Hypokalemia
* Hypochlorhydria or achlorhydria
* Low osmotic gap (<50 mOsm/kg)

* Rash
* Facial flushing
* Dehydration
* Lethargy
* Muscle weakness

* Primary secretory tumor

* Blood VIP levels
* Followed by imaging

Cause  | Duration  | Diarrhea  | Fever  | Abdominal pain  | Weight loss  | GI signs  | Stool exam  | CBC  | Other lab findings  | Extra intestinal findings  | Cause/Pathogenesis  | Gold standard diagnosis
Acute  | Chronic  | Watery  | Bloody  | Fatty  | WBC  | RBC  | Ova/Parasite  | Osmotic gap  | Other  | WBC  | Hgb  | Plt
Medications

* ACE inhibitors
* Digoxin
* Cephalosporins
* Statins
* Thiazide diuretics
* Triptans
* Lactulose
* Anti retroviral agents
* Chemotherapeutic agents
* Antifungals
* Magnesium

| \+  | \+  | \+  | –  | ±  | ±  | \+  | \+  |

* Abdominal distention
* Dehydration

| –  | –  | –  | ↑/↓  | –  | ↑  | Nl  | Nl  |

* Elevated plasma level of drug

| –  |

* Inflammation
* Pseudomembranous colitis

* Clinical evaluation after discontinuation of the drugs

Factitious diarrhea  | \+  | \+  | \+  | –  | –  | –  | \+  | \+  |

* Abdominal distention

| –  | –  | –  | ↑/↓  | –  | Nl  | Nl  | Nl  |

* Hypokalemia
* Metabolic alkalosis
* Hypermagnesemia

* Malabsorption
* Lethargy
* Generalized weakness
* Acute renal failure

* Medications

* Clinical evaluation after discontinuation of the drugs

Cause  | Duration  | Diarrhea  | Fever  | Abdominal pain  | Weight loss  | GI signs  | Stool exam  | CBC  | Other lab findings  | Extra intestinal findings  | Cause/Pathogenesis  | Gold standard diagnosis
Acute  | Chronic  | Watery  | Bloody  | Fatty  | WBC  | RBC  | Ova/Parasite  | Osmotic gap  | Other  | WBC  | Hgb  | Plt
Organophosphate poisoning | \+  | \+  | \+  | –  | –  | –  | \+  | –  |

* Salivation
* Vomiting

| –  | –  | –  | Nl  | –  | Nl  | Nl  | Nl  |

* Reduced RBC acetylcholinesterase
* Plasma cholinesterase activity

* Autonomic dysfunction
* Motor deficit
* Sensory deficit
* Bronchospasm
* Urination
* Miosis
* Bradycardia
* Lacrimation
* Sweating
* Cardiac arrhythmias
* Acute renal injury

* Neurotoxins bind to acetylcholinesterase (AChE)

* Clinical diagnosis

Opium withdrawal | \+  | \+  | \+  | –  | –  | –  | \+  | –  |

* Hyperactive bowel sounds

| –  | –  | –  | Nl  | –  | Nl  | Nl  | Nl  |

* Azotemia
* Hypokalemia
* Metabolic alkalosis

* Dysphoria
* Restlessness
* Sweating
* Rhinorrhea
* Lacrimation
* Myalgia
* Arthralgia

* Opium withdrawal

* Clinical diagnosis following opium withdrawal

Short bowel syndrome | \+  | \+  | \+  | –  | \+  | –  | –  | \+  |

* Abdominal distention
* Abdominal tenderness

| –  | –  | –  | Nl  |

* Positive fecal fat

| Nl  | ↓  | ↑  |

* Hypoalbuminemia
* High level of acute phase reactant
* Abnormal liver function tests

* Prior intestinal surgery
* Malabsorption
* Crohn's disease
* Malignancy
* Peripheral edema
* Muscle atrophy

* Surgical bowel resection

* Clinical diagnosis following bowel resection

Radiation enteritis | \+  | \+  | \+  | \+  | \+  | –  | \+  | \+  |

* Abdominal tenderness

| \+  | \+  | –  | Nl  |

* Positive fecal fat

| Nl  | ↓  | Nl  |

* Vitamin B12 deficiency
* Hypoalbuminemia

* Prior history of malignancy and radiation therapy
* Malabsorption
* Telangiectasias

* Radiation

* Segmental bowel inflammation on endoscopy or colonoscopy

## References

[edit | edit source]

1. ↑ Casburn-Jones, Anna C; Farthing, Michael Jg (2004). "Traveler's diarrhea". Journal of Gastroenterology and Hepatology. 19 (6): 610–618. doi:10.1111/j.1440-1746.2003.03287.x. ISSN 0815-9319.
2. ↑ Kamat, Deepak; Mathur, Ambika (2006). "Prevention and Management of Travelers' Diarrhea". Disease-a-Month. 52 (7): 289–302. doi:10.1016/j.disamonth.2006.08.003. ISSN 0011-5029.
3. ↑ Pfeiffer, Margaret L.; DuPont, Herbert L.; Ochoa, Theresa J. (2012). "The patient presenting with acute dysentery – A systematic review". Journal of Infection. 64 (4): 374–386. doi:10.1016/j.jinf.2012.01.006. ISSN 0163-4453.
4. ↑ Barr W, Smith A (2014). "Acute diarrhea". Am Fam Physician. 89 (3): 180–9. PMID 24506120.
5. ↑ Amil Dias J (2017). "Celiac Disease: What Do We Know in 2017?". GE Port J Gastroenterol. 24 (6): 275–278. doi:10.1159/000479881. PMID 29255768.
6. ↑ Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi A (2017). "Shigellosis". Lancet. doi:10.1016/S0140-6736(17)33296-8. PMID 29254859. Vancouver style error: initials (help)
7. ↑ Yamamoto-Furusho, J.K.; Bosques-Padilla, F.; de-Paula, J.; Galiano, M.T.; Ibañez, P.; Juliao, F.; Kotze, P.G.; Rocha, J.L.; Steinwurz, F.; Veitia, G.; Zaltman, C. (2017). "Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation". Revista de Gastroenterología de México. 82 (1): 46–84. doi:10.1016/j.rgmx.2016.07.003. ISSN 0375-0906.
8. ↑ Borbély, Yves M; Osterwalder, Alice; Kröll, Dino; Nett, Philipp C; Inglin, Roman A (2017). "Diarrhea after bariatric procedures: Diagnosis and therapy". World Journal of Gastroenterology. 23 (26): 4689. doi:10.3748/wjg.v23.i26.4689. ISSN 1007-9327.
9. ↑ Crawford, Sue E.; Ramani, Sasirekha; Tate, Jacqueline E.; Parashar, Umesh D.; Svensson, Lennart; Hagbom, Marie; Franco, Manuel A.; Greenberg, Harry B.; O'Ryan, Miguel; Kang, Gagandeep; Desselberger, Ulrich; Estes, Mary K. (2017). "Rotavirus infection". Nature Reviews Disease Primers. 3: 17083. doi:10.1038/nrdp.2017.83. ISSN 2056-676X.
10. ↑ Kist M (2000). "[Chronic diarrhea: value of microbiology in diagnosis]". Praxis (Bern 1994) (in German). 89 (39): 1559–65. PMID 11068510.CS1 maint: Unrecognized language (link)
11. ↑ Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH (1985). "Evaluation and diagnosis of acute infectious diarrhea". Am. J. Med. 78 (6B): 91–8. PMID 4014291.
12. ↑ López-Vélez R, Turrientes MC, Garrón C, Montilla P, Navajas R, Fenoy S, del Aguila C (1999). "Microsporidiosis in travelers with diarrhea from the tropics". J Travel Med. 6 (4): 223–7. PMID 10575169.
13. ↑ Wahnschaffe, Ulrich; Ignatius, Ralf; Loddenkemper, Christoph; Liesenfeld, Oliver; Muehlen, Marion; Jelinek, Thomas; Burchard, Gerd Dieter; Weinke, Thomas; Harms, Gundel; Stein, Harald; Zeitz, Martin; Ullrich, Reiner; Schneider, Thomas (2009). "Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas". Scandinavian Journal of Gastroenterology. 42 (3): 391–396. doi:10.1080/00365520600881193. ISSN 0036-5521.
14. ↑ Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA (2017). "75SeHCAT scan in bile acid malabsorption in chronic diarrhoea". Rev Esp Med Nucl Imagen Mol. 36 (1): 37–47. doi:10.1016/j.remn.2016.08.005. PMID 27765536.
15. ↑ Gibson RJ, Stringer AM (2009). "Chemotherapy-induced diarrhoea". Curr Opin Support Palliat Care. 3 (1): 31–5. doi:10.1097/SPC.0b013e32832531bb. PMID 19365159.
16. ↑ Abraham BP, Sellin JH (2012). "Drug-induced, factitious, & idiopathic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 633–48. doi:10.1016/j.bpg.2012.11.007. PMID 23384808.
17. ↑ Reintam Blaser A, Deane AM, Fruhwald S (2015). "Diarrhoea in the critically ill". Curr Opin Crit Care. 21 (2): 142–53. doi:10.1097/MCC.0000000000000188. PMID 25692805.
18. ↑ McMahan ZH, DuPont HL (2007). "Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy". Aliment. Pharmacol. Ther. 25 (7): 759–69. doi:10.1111/j.1365-2036.2007.03261.x. PMID 17373914.
19. ↑ Schiller LR (2012). "Definitions, pathophysiology, and evaluation of chronic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 551–62. doi:10.1016/j.bpg.2012.11.011. PMID 23384801.
20. ↑ Giannella RA (1986). "Chronic diarrhea in travelers: diagnostic and therapeutic considerations". Rev. Infect. Dis. 8 Suppl 2: S223–6. PMID 3523719.
21. ↑ Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
22. ↑ Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.CS1 maint: Multiple names: authors list (link)
23. ↑ Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
24. ↑ RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.CS1 maint: Multiple names: authors list (link)
25. ↑ Konvolinka CW (1994). "Acute diverticulitis under age forty". Am J Surg. 167 (6): 562–5. PMID 8209928.
26. ↑ Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006). "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications". Gut. 55 (6): 749–53. doi:10.1136/gut.2005.082909. PMC 1856208. PMID 16698746.CS1 maint: Multiple names: authors list (link)
27. ↑ Haque R, Huston CD, Hughes M, Houpt E, Petri WA (2003). "Amebiasis". N Engl J Med. 348 (16): 1565–73. doi:10.1056/NEJMra022710. PMID 12700377.CS1 maint: Multiple names: authors list (link)
28. ↑ Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.
29. ↑ Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.CS1 maint: Multiple names: authors list (link)
30. ↑ BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.