Read N W, Krejs G J, Read M G, Santa Ana C A, Morawski S G, Fordtran J S
Gastroenterology. 1980 Feb;78(2):264-71.
We studied 27 patients with severe chronic diarrhea for which extensive investigations carried out at other institutions had failed to reveal a diagnosis. They were studied by standard diagnostic methods as well as by careful fecal analysis and intestinal perfusion. If they were incontinent of feces, anal sphincter function tests were performed. Although many were suspected of having pancreatic cholera syndrome, this diagnosis could not be established in a single patient. The most common diagnosis that could be established was surreptitious ingestion of drugs (laxatives in 7 patients and diuretics in 2). Other specific diagnoses included ulcerative colitis in 2 patients, allergy to beef in 1, and bacterial overgrowth of the small intestine in 1. Thus, we were able to establish a specific diagnosis in 13 patients. Of the remaining 14 patients, 8 had findings suggestive of irritable bowel syndrome, and 2 others had anal sphincter dysfunction as the major cause of their disability. The other 4 undiagnosed patients had severe secretory (3 patients) or osmotic (1 patient) diarrhea. Follow-up interviews at 6 mo-6 yr failed to reveal evidence of a cause for diarrhea that had been overlooked during our studies. The diagnostic approach to patients with unexplained diarrhea is discussed. The importance of a search for surreptitious drug ingestion and accurate measurement of bowel movement frequency and stool weight is emphasized.
我们研究了27例严重慢性腹泻患者，其他机构对这些患者进行了广泛检查，但均未明确诊断。我们采用标准诊断方法以及仔细的粪便分析和肠道灌注对他们进行了研究。如果患者大便失禁，则进行肛门括约肌功能测试。尽管许多患者被怀疑患有胰性霍乱综合征，但无一例确诊。最常见的确诊诊断是药物的隐匿性摄入（7例服用泻药，2例服用利尿剂）。其他明确诊断包括2例溃疡性结肠炎、1例对牛肉过敏和1例小肠细菌过度生长。因此，我们能够对13例患者做出明确诊断。其余14例患者中，8例有提示肠易激综合征的表现，另外2例以肛门括约肌功能障碍为主要致残原因。其他4例未确诊患者有严重的分泌性腹泻（3例）或渗透性腹泻（1例）。在6个月至6年的随访访谈中，未发现有在我们研究期间被忽视的腹泻病因。本文讨论了对不明原因腹泻患者的诊断方法。强调了寻找隐匿性药物摄入以及准确测量排便频率和粪便重量的重要性。
