Fernández-Bañares Fernando, Esteve Maria, Salas Antonio, Alsina Montserrat, Farré Carme, González Clarisa, Buxeda Montse, Forné Montserrat, Rosinach Mercé, Espinós Jorge C, Maria Viver Josep
Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain.
Am J Gastroenterol. 2007 Nov;102(11):2520-8. doi: 10.1111/j.1572-0241.2007.01438.x. Epub 2006 Aug 4.
BACKGROUND Causes of chronic watery diarrhea are multiple. There is not definite scientific evidence about AND AIMS: which are the recommended explorations to be performed in the diagnostic workup of patients with functional diarrhea. The aim was to assess prospectively the presence of gluten-sensitive enteropathy, bile acid malabsorption, and sugar malabsorption in consecutive patients with chronic watery diarrhea of obscure origin fulfilling Rome II criteria of functional disease.
A total of 62 patients with chronic watery diarrhea, defined as more than 3 loose or liquid bowel movements a day for at least 4 wk and a stool weight >200 g/day were included. The following tests were performed: (a) HLA-DQ2/DQ8 genotyping, and if positive, endoscopic biopsies from distal duodenum were obtained, and intestinal damage assessed; (b) SeHCAT (Se-homotaurocholate) abdominal retention test; (c) small bowel follow-through; and (d) hydrogen breath test (lactose, fructose + sorbitol). Gluten- or sugar-free diet, or cholestyramine was administered according to results. Functional disease was diagnosed if all tests performed were normal or if either there was no response to specific therapy or diarrhea relapsed during a 12-month follow-up.
Bile acid malabsorption was considered to be the cause of diarrhea in 28 (45.2%) patients, sugar malabsorption in 10 (16.1%), gluten-sensitive enteropathy in 10 (16.1%), and both bile acid and sugar malabsorption in 2 patients. Twelve (19.4%) patients remained without a specific diagnosis and were considered as functional bowel disease. Diarrhea stopped in the 50 patients after specific treatment, decreasing the daily stool number from 5.4 +/- 0.3 to 1.5 +/- 0.1 (P < 0.0005), without relapse after the 12-months follow-up.
The diagnosis of functional disease in patients with chronic watery diarrhea should be performed with caution since in most cases there is an organic cause that justifies diarrhea.
背景 慢性水样腹泻的病因多种多样。关于功能性腹泻患者诊断检查中应进行哪些推荐的检查，尚无确切的科学证据。目的：前瞻性评估连续符合功能性疾病罗马Ⅱ标准的不明原因慢性水样腹泻患者中麸质敏感性肠病、胆汁酸吸收不良和糖吸收不良的情况。
共纳入62例慢性水样腹泻患者，定义为每日至少4周出现3次以上稀便或水样便且粪便重量>200 g/天。进行了以下检查：(a) HLA-DQ2/DQ8基因分型，若结果为阳性，则取十二指肠远端内镜活检并评估肠道损伤；(b) SeHCAT（硒-同型牛磺胆酸盐）腹部滞留试验；(c) 小肠造影；(d) 氢呼气试验（乳糖、果糖+山梨醇）。根据结果给予无麸质或无糖饮食或考来烯胺治疗。若所有检查结果均正常，或对特异性治疗无反应或在12个月随访期间腹泻复发，则诊断为功能性疾病。
28例（45.2%）患者的腹泻原因被认为是胆汁酸吸收不良，10例（16.1%）是糖吸收不良，10例（16.1%）是麸质敏感性肠病，2例患者同时存在胆汁酸和糖吸收不良。12例（19.4%）患者仍未明确诊断，被视为功能性肠病。50例患者经特异性治疗后腹泻停止，每日排便次数从5.4±0.3次降至1.5±0.1次（P<0.0005），12个月随访后无复发。
慢性水样腹泻患者功能性疾病的诊断应谨慎进行，因为在大多数情况下存在导致腹泻的器质性病因。
