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TABLE 1

Mechanism and etiology of chronic diarrhea


IBD: Inflammatory bowel disease; VIP: Vasoactive intestinal peptide
Mechanisms Results of stool collection Etiologies
Osmotic Fecal osmotic gap > 50 mosmol/kg  Lactase deficiency
 Artificial sugars (mannitol, sorbitol,
etc.)
 Magnesium
 Malabsorption
 Exocrine pancreatic insufficiency
 Bacterial overgrowth

Secretory Fecal osmotic gap < 50 mosmol/kg  Diarrhea caused by enterotoxins (for
example, V. cholerae, E. coli)
 Hormones (serotonin, VIP, gastrin)
 Malabsorption of bile acids
 Collagenous colitis
 Lymphocytic colitis
Inflammatory Neutrophils in stools  IBD
Elevated fecal calprotectin  Radiation colitis
 Entero-invasive infections
(e.g., Shigellosis, Y. enterocolitica,
Entamoeba histolytica)
Motor Normal fecal calprotectin  Irritable bowel syndrome
 Diabetes
 Scleroderma
 Bacterial overgrowth

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