Which of the following causes of diarrhoea decreases after prolonged fasting
High-Yield Explanation
Acute diarrhoea This is extremely common and is usually caused by faecal-oral transmission of bacteria or their toxins, viruses or parasites . Infective diarrhoea is usually sho-lived and patients who present with a history of diarrhoea lasting more than 10 days rarely have an infective cause. A variety of drugs, including antibiotics, cytotoxic drugs, PPIs and NSAIDs, may be responsible. Chronic or relapsing diarrhoea The most common cause is irritable bowel syndrome , which can present with increased frequency of defecation and loose, watery or pellety stools. Diarrhoea rarely occurs at night and is most severe before and after breakfast. At other times, the patient is constipated and there are other characteristic symptoms of irritable bowel syndrome. The stool often contains mucus but never blood, and 24-hour stool volume is less than 200 g. Chronic diarrhoea can be categorised as being caused by disease of the colon or small bowel, or to malabsorption . Clinical presentation, examination of the stool, routine blood tests and imaging reveal a diagnosis in many cases. A series of negative investigations usually implies irritable bowel syndrome but some patients clearly have organic disease and need more extensive investigations. Ref Davidson edition23rd pg 783