Diarrheal Diseases

Celiac sprue (Gluten-sensitive enteropathy):

Diarrhea 2
Dermatitis herpetiformis
  • Flattening villi of proximal small bowel (jejunum)
  • HLA DQ2\DQ8
  • 50% have iron deficiency anemia
  • Associated with: Dermatitis herpetiformis (papulovesicular lesions on extensor surface), DM type 1, other autoimmune, IgA deficiency
  • Diagnosis:
    • Anti-endomysial antibody, Tissue tranglutaminase (tTG), Antigliadin antibody
    • Biopsy to exclude bowel wall lymphoma (minimum of 6 taken from 2nd and 3rd part of duodenum)
    • Gold standard: repeat endoscopy w\biopsy after gluten-free diet.
  • Treatment: gluten-free diet, treat nutritional deficiencies

Whipple disease:

  • Usually in middle-aged men
  • Caused by gram-positive bacillus (Tropheryma whippelii)
  • Presentation: diarrhea, steatorrhea, abdominal pain, wt loss, migratory arthritis, fever, neurologic, cardiac and ophthalmologic manifestations
  • Diagnosis: PAS-positive machrophages containing the bacillus in small bowel, PCR
  • Treatment: trimethoprim-sulfamethoxazole for 1 year

Bacterial overgrowth:

  • Causes:
    • Small bowel stasis: due to anatomic abnormalities (post-surgical), or abnormal motility (DM)
    • Abnormal communication between small bowel and colon (Crohn fistula)
  • Diagnosis:
    • Lactose: hydrogen breath test (early hydrogen peak),
    • 14C-D-Xylose breath test

Irritable bowel syndrome (IBS):Diarrhea 3

  • Sx aggravated by stress
  • Dome III dx criteria:


Inflammatory bowel disease (IBD):



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