JAMA Clinical Reviews Diagnosis and Treatment of Chronic, Noninfectious Diarrhea
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Mar 2, 2026 William Chey, a gastroenterologist and academic leader at the University of Michigan, discusses chronic noninfectious diarrhea. He covers definitions and prevalence, the roles of IBS-D and functional diarrhea, and key history questions. Bile acid diarrhea and microscopic colitis are highlighted, along with recommended baseline tests and indications for endoscopy. Practical treatments and the low FODMAP diet are also reviewed.
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Definition And Prevalence Of Chronic Diarrhea
- Chronic diarrhea is defined by loose to watery stool consistency lasting more than four weeks.
- It affects about 6%–7% of US adults, roughly 22–24 million people, making it a common clinical problem.
IBS And Functional Diarrhea Are The Top Causes
- The two leading causes of chronic noninfectious diarrhea are irritable bowel syndrome with diarrhea and functional diarrhea.
- IBS-D includes abdominal pain while functional diarrhea lacks predominant pain, both are disorders of gut–brain interaction.
Ask Specific History To Classify Diarrhea
- Ask about stool consistency, frequency, urgency, incontinence, meal relation, and nocturnal symptoms to classify diarrhea type.
- Meal-related or fasting-resolving diarrhea suggests osmotic causes; persistent or nocturnal diarrhea suggests secretory causes.