PARIS — Most diarrhea that leads patients to seek medical advice is actually a false alarm, said gastroenterologist Nassim Hammoudi, MD, PhD, of the Lariboisière Hospital in Paris, during France's annual general medicine conference (JNMG 2023). He said that doctors need to understand the characteristics of chronic diarrhea and adapt its management accordingly. In his presentation, Hammoudi highlighted the clinical signs that should be considered.
Mechanisms of Chronic Diarrhea
Chronic diarrhea can result from different mechanisms, such as motility disorders related to accelerated intestinal transit, malabsorption, osmotic diarrhea, and secretory diarrhea, which are often interlinked. When an endoscopy is performed, it is recommended to conduct multi-level biopsies to detect microscopic colitis, which Hammoudi believes is "probably underdiagnosed."
Diarrhea is defined as the passage of frequent stools (more than three a day), soft to liquid in consistency, and a daily weight exceeding 300 g. It is considered chronic when it persists for more than a month.
Identifying False Diarrhea
Practitioners must first distinguish between genuine and false diarrhea, with the latter presenting in most consultations. "Thorough questioning is fundamental," Hammoudi emphasized. It is essential to determine the daily stool count, the presence of nocturnal stools, and stool consistency. "A soft stool passed once a day is not diarrhea," he said.
