Acute diarrhea is a diarrheal illness occurring for up to two weeks. Once diarrhea lasts beyond 2 weeks it is called Persistent Diarrhea. If diarrhea persists beyond 4 weeks, it is called Chronic Diarrhea.
What causes acute diarrhea? Acute diarrhea can be caused by one of many food-borne pathogens due to ingestion of undercooked foods such as beef and poultry. Some bacteria create toxins that result in rapid onset of symptoms after ingestion. Other infectious agents include viruses, parasites, or travel-related bacterial changes. Non-infectious agents include simple food intolerances, or medication effects. Typically, a careful history may uncover important clues such as recent travel, use of antibiotics, sick contacts, or new medications.
When should you seek medical attention?You should see a doctor if you during your illness you develop fever > 100.3, abdominal pain, bloody stools, or persistent vomiting and inability to tolerate oral hydration. Consider seeing your primary care doctor an urgent care doctor as first step otherwise a gastroenterologist or hospital emergency room.
What type of testing can be done in the setting of acute diarrhea?Traditional stool testing involves microbiological techniques to culture or grow pathogens under permissive growth conditions, the use of antibodies, microscopy, or stool polymerase chain reaction (PCR). Stool testing by PCR amplifies and detects small amounts of DNA from a variety of KNOWN pathogens and is gaining popularity in hospital settings given its rapid 24-hour turnaround. These tests are available at Gotham Medical Associates but can have a higher cost to the patient compared to traditional stool testing. Further, because the test is very sensitive a number of pathogens can be found in a single sample. Results have to be interpreted with caution as the high sensitivity can lead to false positives. This happens because DNA is everywhere and may not necessarily mean that the bacteria or pathogen associated with the DNA is actually present and causing the diarrhea. Stool PCR tests give us a fingerprint of what MAY be causing the diarrhea but can’t always pinpoint the active pathogen. Unlike PCR, stool culture or microscopy shows us what is actually present (if able to be grown), not what used to be there. Keep in mind, companies that perform Stool PCR for pathogens do not culture the stool for confirmation. The advantage to the Stool PCR is it gives a 24 hour turn around while stool culture can be 3-5 days.
What is the possible outcome from acute diarrhea? Most cases of acute diarrhea resolve spontaneously and are difficult to attribute to a single pathogen or cause. However, some patients may develop persistent (lasting > 2 weeks) or chronic diarrhea (lasting > 4weeks). Sometimes patients who experience an acute infectious case of diarrhea may develop more prolonged alterations in their bowel patterns including irregularity, change in frequency, pattern, or consistency. This can be accompanied by discomfort and urgency and is called Post-infectious irritable bowel syndrome (IBS). On the other-hand, some patients may actually have a chronic illness such as Inflammatory bowel disease (IBD) that presented abruptly. It’s possible that the patient had underlying inflammation in the intestine that was subclinical (asymptomatic) for some time before the onset of symptoms. A gastroenterologist is trained to differentiate between these two scenarios.
How beneficial are antibiotics in treating acute diarrhea?In general, most cases of acute diarrhea caused by bacteria will resolve on in 1-2 weeks without antibiotics. Antibiotics are often overprescribed for acute diarrhea and treatment may only reduce the course of the illness on average by a day or so. Further, antibiotics may pose more risks than benefits as they can lead to unintended side-effects, allergic drug reactions, or development in susceptible individuals of an antibiotic-associated diarrheal infection, called Clostridium difficile (c. diff) colitis. This bacterium may be asymptomatically carried in the gut as a dormant spore form and then activate to produce toxins that cause colon inflammation or colitis.On the other hand, treatment with antibiotics may be warranted in patients that are elderly, immunocompromised (HIV, Cancer patients, Transplant recipient) or in pregnant patients, as the risk of not treating may outweigh risks of treatment. Finally, some cases of diarrhea are not caused by bacteria, rather the cause is a virus or a parasite. Viruses are not affected by antibiotics and some parasites requires very specific medications that can only be decided up once the parasite is isolated and identified.
Is it safe to use Imodium? This question is best answered by a physician that can completely evaluate you by taking a careful history, physical exam, and blood/stool testing. Once infectious etiologies are rule out by stool testing it may be safe to use Imodium or other diarrheal medications, but this should only be done based on your doctor’s recommendation. It’s usually best to let the diarrhea run its course and ensure adequate hydration and nutrition.
What is safe to eat when dealing with diarrhea?Its best to avoid products containing dairy, high fat content, or rich foods. Its most important to stay well hydrated to keep up with losses of fluids in the stools. The BRAT diet is typically suggested.