Etiology of chronic non-bloody diarrhoea without fever

There are a number of causes. Giardiasis is common. Other intestinal parasites (such as Cyclospora) can cause a similar picture. At present there is still no effective treatment for cryptosporidiosis. Pellagra (niacin deficiency) is characterised by the DDD triad: diarrhoea, dermatitis, dementia. This triad is not seen in all patients. Treatment with niacin brings about a rapid improvement. Overactivity of the thyroid gland (hyperthyroidism) can be accompanied by persistent diarrhoea. There is usually also tachycardia and tremor. Congenital lactase deficiency is common in Africa in people who traditionally do not breed cattle and where milk is not included in the staple diet. It causes abdominal pain and diarrhoea in people who consume products containing lactose, such as milk. Because lactose breath tests and intestinal biopsies for determining enzymes cannot be carried out in most developing countries, a challenge test with milk can be performed instead. If the patient has no discomfort after drinking a large glass of milk, there is no clinically relevant lactase deficiency.

Campylobacter infections and some strains of Esch. coli can also cause persistent diarrhoea. After acute infectious diarrhoea a patient can still suffer from a less serious form of diarrhoea for several weeks or months. In these circumstances there may be a secondary lactase deficiency. Malnutrition and a poor general condition in children prolong the symptoms.

Category: Medical Subject Notes , Medicine Notes