Drug-induced microscopic colitis
Secretory diarrhea is characterized by excessive secretions by the digestive tract, leading to significant potassium loss. This type of diarrhea is not related to food intake and is resistant to fasting.
Major causes of secretory diarrhea include microscopic colitis, parasitic infections, and endocrine tumors. Between 10% and 15% of patients with chronic diarrhea and apparently normal colonoscopy have microscopic colitis.
Dr. Hammoudi advised specialists seeking to determine the cause of chronic diarrhea to routinely collect multilevel bowel biopsies during colonoscopies from macroscopically normal mucosa to rule out microscopic colitis.
Microscopic colitis is mainly linked to the use of medications like PPIs and NSAIDs. These drugs can induce malabsorption-related diarrhea by damaging the intestinal wall.
In addition to discontinuing the implicated medication, the treatment for microscopic colitis includes low-dose budesonide (multiple brands). Biologics used in IBD may also be considered in cases of recurrent colitis.
Finally, exudative enteropathy can be a distinct cause of chronic diarrhea. It is characterized by albumin leakage (Waldmann’s disease) and manifests with edema, malnutrition, and significant hypoalbuminemia.
This article was translated from the Medscape French edition. A version of this article appeared on Medscape.com.