[Chronic diarrhea--rational diagnosis and therapy].

Chronic diarrhea, defined by frequent bowel movements with decreased stool consistency lasting for longer than 3 weeks represents a major problem in gastroenterology. In addition to the very frequent functional disturbances of irritable bowel syndrome a wide variety of infectious, drug-induced, alimentary, metabolic, hormonal and organic causes requires a thorough evaluation of this symptom. To reach diagnosis an algorithm applying a wide array of diagnostic procedures based on the results of thorough anamnesis, physical examination and stool visit should be followed. In addition to alleviation of symptoms, reconstitution and prevention of nutrional deficits (volume, electrolytes, trace elements, vitamines, calories) therapeutic approaches should eliminate underlying causes whenever possible. Symptomatic relief is provided by substances inhibiting secretion and motility as the opiatagonist Loperamid or anticholinergics. Substitution of vitamins, trace elements, calories, enzymes or bile salts should be adapted to the individual needs. Elimination of a cause of chronic diarrhea is generally provided be anti-infectious therapy, other causes however (e.g. sprue by the elimination of gliadin from diet) may be treated effectively as well.