Urgent workup of chronic diarrhea

Dr Robin Spiller is a professor of gastroenterology in the Faculty of Medicine and Health Sciences at the University of Nottingham and member of the Board of the Rome Foundation.

What warrants urgent diagnostic workup in patients with chronic diarrhea?

Robin Spiller, MB BChir (Cantab), MSc, MD: It depends on what you mean by “chronic.” If it is more than 6 months, then certainly there is less fear that you are missing a malignancy, because it would have declared itself within that time. I suppose weight loss would be an important point, meaning that you should investigate. Obviously anemia would be a cause for investigation. Family history might be relevant. If somebody says, “I have got a family history of pancreatic cancer” that would be a reason to investigate urgently. What the impact on the patient is, I suppose, would be a driver too. So if they are losing weight, have signs of malabsorption, or have vitamin deficiencies, this would all be reasons to put it up.

But I would say that chronic diarrhea is quite socially debilitating. It inhibits people from eating out or traveling, it may interfere with their work. If I had chronic diarrhea, I would want to be investigated.