diarrhea

Celiac disease is an autoimmune disease that can occur through the lifespan and is characterized by immune-mediated enteropathy in response to dietary gluten.1 Celiac disease affects at least 1% of the global population. Important risk factors are a first-degree relative with celiac disease, carrying specific genetic variants, presence of other autoimmune conditions (eg, type 1 diabetes, Hashimoto thyroiditis), and certain chromosomal disorders (eg, Down syndrome, Turner syndrome, Williams syndrome).

Typical gastrointestinal symptoms include diarrhea (38%), abdominal discomfort (34%), and weight loss from malabsorption (16%).2 Subjective improvement in symptoms with a gluten-free diet has a poor positive predictive value (PPV) for celiac disease (36%), making objective testing essential. Diagnostic guidelines (Table) recommend performing serologic testing in individuals with symptoms and/or signs suggestive of celiac disease while they are consuming a diet containing gluten, which is present in wheat, barley, and rye. Gluten reduction or removal from the diet impairs the diagnostic accuracy of screening.3-7 For patients already following a gluten-free diet, gluten consumption must be resumed prior to screening. However, there is no consensus for the dose or duration of gluten consumption that should be maintained through second confirmatory tests. Of the 2 most recent guidelines, one does not specify a dose or duration4 and one suggests at least 3 g per day for at least 6 weeks.3

Author/s:

MD, Marisa G. Stahl, MSCS, Claire Jansson-Knodel

What Is Celiac Disease?

Mary Cervantes — Mon, 17 Aug 2026 17:21:29 +0000

Date Added:

August 17, 2026

Journal/Publication:

JAMA Patient Page

Publisher:

JAMA

Publication Date:

August 12, 2026

URL:

What Is Celiac Disease?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2026.13079

Keywords

MeSH

Information for patients about celiac disease. James W. Mold, MD, MPH

Free full text

View

Celiac disease is a chronic autoimmune disease caused by consumption of gluten in people with specific genetic markers. Celiac disease affects about 1% of people worldwide and people can start having symptoms at any age. Individuals at increased risk include those with a first-degree relative who has celiac disease and those with autoimmune diseases (eg, type 1 diabetes or Hashimoto thyroiditis) and certain chromosomal conditions (Down syndrome, Turner syndrome, or Williams syndrome).

Author/s:

Kristin L. Walter

Chronic, Noninfectious Diarrhea A Review

Nathan Hinkle — Mon, 20 Apr 2026 20:01:38 +0000

Date Added:

April 20, 2026

Journal/Publication:

Journal of the American Medical Association

Publisher:

The American Medical Association

Publication Date:

March 2, 2026

Issue:

Volume:

335

Pages:

1250-1262

URL:

Chronic, Noninfectious Diarrhea A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi:10.1001/jama.2026.0872

Keywords

Diarrhea

Irritable Bowel Syndrome

MeSH

celiac disease

Irritable Bowel Syndrome

Defecation

diarrhea

RPR Commentary: A review of the diagnosis and treatment of patients with chronic non-infectious diarrhea. Remember to always consider the side effects of current medications and supplements first before thinking of other causes. James W. Mold, MD, MPH

Free full text

View

Chronic diarrhea is defined as loose or watery stools lasting longer than 4 weeks and affects approximately 6% to 7% of adults in the US. More than 90% of patients with chronic diarrhea have a noninfectious etiology.

Observations The most common causes of chronic, noninfectious diarrhea are irritable bowel syndrome with diarrhea (IBS-D) and functional diarrhea. IBS-D typically presents with recurrent abdominal pain relieved or worsened after defecation. Functional diarrhea is a condition in which more than 25% of bowel movements in the preceding 3 months are loose or watery, but it is not associated with significant abdominal pain. Chronic diarrhea due to a small-bowel source, such as celiac disease or small intestinal bacterial overgrowth, is typically associated with large-volume diarrhea and weight loss, with or without steatorrhea. Celiac disease is an autoimmune condition defined by enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals, and small intestinal bacterial overgrowth is characterized by excessive bacteria in the small bowel. Chronic diarrhea due to colon pathology, such as bile acid diarrhea and microscopic colitis, typically presents with frequent, low-volume stools, with or without urgency and excess mucus. Bile acid diarrhea is characterized by excess bile acids in the colon, and microscopic colitis is characterized by chronic inflammation on colon biopsies despite normal endoscopic appearance. Evaluation of chronic diarrhea includes serological testing for celiac disease (tissue transglutaminase immunoglobulin A, along with total immunoglobulin A) and stool testing for fecal calprotectin to evaluate for inflammatory bowel disease. Patients with gastrointestinal bleeding, unexplained weight loss, 45 years or older, nocturnal diarrhea, steatorrhea, and/or iron deficiency anemia should undergo colonoscopy to evaluate for colorectal cancer as well as upper endoscopy. During colonoscopy, random biopsies are recommended to evaluate for microscopic colitis, which affects 13% of patients with chronic diarrhea. If evaluation does not identify a cause of chronic diarrhea, likely diagnoses are IBS-D or functional diarrhea and the patient should be treated with lifestyle modification, such as regularly scheduled meals, exercise, intake of at least 8 cups of noncaffeinated fluids daily, limiting caffeine to 3 cups or fewer daily, and avoiding alcohol and carbonated beverages. For general treatment of chronic diarrhea, dietary modifications, such as consuming a diet low in fermentable oligosaccharides (legumes, wheat, onions, garlic), disaccharides (lactose), and monosaccharides (fructose), and polyols (sorbitol, mannitol), or medications, such as opiate agonists (loperamide), anticholinergics (hyoscyamine, dicyclomine), or 5-hydroxytryptamine 3 receptor (5-HT3) antagonists (ondansetron), can be prescribed. These therapies typically improve diarrhea in 50% to 80% of patients.

Conclusions and Relevance The most common causes of chronic, noninfectious diarrhea include IBS-D and functional diarrhea. Diagnostic testing should include consideration of celiac disease, inflammatory bowel disease, and microscopic colitis. Empiric therapies for chronic diarrhea include lifestyle and dietary modifications and medications, including opiate agonists, anticholinergics, and 5-HT3 antagonists.

Author/s:

Prashant Singh, Allen Lee, Neil M Sheth, William D Chey

Chronic, Noninfectious Diarrhea: A Review

Megan George — Wed, 04 Mar 2026 18:21:26 +0000

Date Added:

March 4, 2026

Journal/Publication:

JAMA

Publication Date:

March 2, 2026

URL:

Chronic, Noninfectious Diarrhea: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2026.0872

Keywords

Diarrhea

infectious diarrhea

Irritable Bowel Syndrome

abdominal pain

Defecation

Steatorrhea

PMID (1):

41770539

MeSH

diarrhea

Irritable Bowel Syndrome

abdominal pain

Defecation

Steatorrhea

An in-depth review of the evaluation and management of chronic non-infectious diarrhea. James W. Mold, MD, MPH

View

Importance: Chronic diarrhea is defined as loose or watery stools lasting longer than 4 weeks and affects approximately 6% to 7% of adults in the US. More than 90% of patients with chronic diarrhea have a noninfectious etiology.

Observations: The most common causes of chronic, noninfectious diarrhea are irritable bowel syndrome with diarrhea (IBS-D) and functional diarrhea. IBS-D typically presents with recurrent abdominal pain relieved or worsened after defecation. Functional diarrhea is a condition in which more than 25% of bowel movements in the preceding 3 months are loose or watery, but it is not associated with significant abdominal pain. Chronic diarrhea due to a small-bowel source, such as celiac disease or small intestinal bacterial overgrowth, is typically associated with large-volume diarrhea and weight loss, with or without steatorrhea. Celiac disease is an autoimmune condition defined by enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals, and small intestinal bacterial overgrowth is characterized by excessive bacteria in the small bowel. Chronic diarrhea due to colon pathology, such as bile acid diarrhea and microscopic colitis, typically presents with frequent, low-volume stools, with or without urgency and excess mucus. Bile acid diarrhea is characterized by excess bile acids in the colon, and microscopic colitis is characterized by chronic inflammation on colon biopsies despite normal endoscopic appearance. Evaluation of chronic diarrhea includes serological testing for celiac disease (tissue transglutaminase immunoglobulin A, along with total immunoglobulin A) and stool testing for fecal calprotectin to evaluate for inflammatory bowel disease. Patients with gastrointestinal bleeding, unexplained weight loss, 45 years or older, nocturnal diarrhea, steatorrhea, and/or iron deficiency anemia should undergo colonoscopy to evaluate for colorectal cancer as well as upper endoscopy. During colonoscopy, random biopsies are recommended to evaluate for microscopic colitis, which affects 13% of patients with chronic diarrhea. If evaluation does not identify a cause of chronic diarrhea, likely diagnoses are IBS-D or functional diarrhea and the patient should be treated with lifestyle modification, such as regularly scheduled meals, exercise, intake of at least 8 cups of noncaffeinated fluids daily, limiting caffeine to 3 cups or fewer daily, and avoiding alcohol and carbonated beverages. For general treatment of chronic diarrhea, dietary modifications, such as consuming a diet low in fermentable oligosaccharides (legumes, wheat, onions, garlic), disaccharides (lactose), and monosaccharides (fructose), and polyols (sorbitol, mannitol), or medications, such as opiate agonists (loperamide), anticholinergics (hyoscyamine, dicyclomine), or 5-hydroxytryptamine 3 receptor (5-HT3) antagonists (ondansetron), can be prescribed. These therapies typically improve diarrhea in 50% to 80% of patients.

Conclusions and relevance: The most common causes of chronic, noninfectious diarrhea include IBS-D and functional diarrhea. Diagnostic testing should include consideration of celiac disease, inflammatory bowel disease, and microscopic colitis. Empiric therapies for chronic diarrhea include lifestyle and dietary modifications and medications, including opiate agonists, anticholinergics, and 5-HT3 antagonists.

Author/s:

Prashant Singh, Allen Lee, Neil M. Sheth

What Is Ulcerative Colitis?

Erin Blanchette — Mon, 12 Feb 2024 16:55:58 +0000

Date Added:

February 12, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

February 2, 2024

Issue:

Volume:

330

Pages:

951-965

URL:

What Is Ulcerative Colitis?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2023.23814

Keywords

ulcerative colitis

Diarrhea

Gastroenterology

Inflammatory Bowel Disease

PMID (1):

38306113

MeSH

Information for patients about ulcerative colitis. James W. Mold, MD, MPH

Free full text

View

This JAMA Patient Page describes the condition of ulcerative colitis and its symptoms, diagnosis, and treatment options.

Author/s:

Rebecca Voelker

Treatment of Clostridioides difficile Infection

Aubrey Delammermore — Sat, 10 Sep 2022 05:00:00 +0000

Date Added:

September 10, 2022

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

September 6, 2022

Issue:

Volume:

328

Pages:

881-882

URL:

Treatment of Clostridioides difficile Infection

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2022.12251

Keywords

PMID (1):

35939317

MeSH

Clostridioides difficile*

Clostridium infections* / drug therapy

Cross infection

diarrhea

Clostridium Infections

An evidence-based summary of the treatment of Clostridium difficile infections. James W. Mold, MD, MPH

Free full text

View

Clostridioides difficile infection is a common nosocomial and community-acquired cause of diarrhea, with an estimated 453 000 cases per year in the United States.1 Treatment of CDI is based on severity and recurrence risk.

Author/s:

Sehgal, K., Cifu, A. S., Khanna, S.

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

John Bayhi — Fri, 14 Feb 2020 17:29:39 +0000

Date Added:

February 14, 2020

Journal/Publication:

Lancet

Publisher:

Elsevier Ltd.

Publication Date:

February 15, 2020

Issue:

10223

Volume:

395

Pages:

507-513

URL:

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/S0140-6736(20)30211-7

Keywords

coronavirus

2019-nCOV

2019 novel coronavirus

pneumonia

China

PMID (1):

32007143

I thought you might want to see this information regarding the presentations of patients with the novel coronavirus. James W. Mold, MD, MPH

Free full text

View

BACKGROUND:

In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia.

METHODS:

In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020.

FINDINGS:

Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure.

INTERPRETATION:

The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection.

FUNDING:

National Key R&D Program of China.

Author/s:

Chen, N, Zhou, M, Dong, X, Qu, J, Gong, F, Han, Y, Qiu, Y, Wang, J, Liu, Y, Wei, Y, Xia, J, Yu, T, Zhang, X, Zhang, L

Cannabidiol Products Are Everywhere, but Should People Be Using Them?

Brian Desmarais — Thu, 21 Nov 2019 18:13:38 +0000

Date Added:

November 22, 2019

Journal/Publication:

Journal of the American Medical Association

Publication Date:

November 20, 2019

URL:

Cannabidiol Products Are Everywhere, but Should People Be Using Them?

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1001/jama.2019.17361

Keywords

CBD

MeSH

cannabis

cannabidiol

united states food and drug administration

Here is another concise review on cannabidiol. This one looks like it could be useful to give to patients who have questions about it. James W. Mold, MD, MPH

Free full text

View

Even with pharmaceutical-grade CBD, potentially dangerous adverse events can occur. With unregulated CBD products, the adverse events are unpredictable, in part because their ingredients might not be the same as those listed on the package.

Author/s:

Rubin, R.

Diagnosis and Management of Infectious Diarrhea

Tracy Ashby — Fri, 15 Feb 2019 06:00:00 +0000

Date Added:

February 15, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

February 14, 2019

URL:

Diagnosis and Management of Infectious Diarrhea

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2018.21974

Keywords

infectious diarrhea

stool testing

PMID (1):

30763429

MeSH

dysentery

diarrhea

diagnostic tests, routine

cause of death

anti-bacterial agents

abdominal pain

A guideline for the diagnosis and management of infectious diarrhea from the Infectious Disease Society of America.

View

Infectious diarrhea is the fifth leading cause of death worldwide. In the United States, 179 million cases of acute diarrhea occur per year. Most diarrheal illnesses are self-limited and do not require evaluation or treatment beyond supportive care such as rehydration. Some infections do require antimicrobial therapy, and appropriate use of diagnostic tests and treatments may potentially minimize unnecessary costs, decrease adverse events, optimize clinical outcomes, and limit antibiotic resistance.

Author/s:

Hamilton, Keith W., Cifu, Adam S.