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Approach to the adult with acute diarrhea in resource-rich settings

Christine A Wanke, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


Diarrheal diseases represent one of the five leading causes of death worldwide [1,2]. Morbidity and mortality can be significant even in resource-rich settings, where diarrhea is more often than not a "nuisance disease" in the normally healthy individual [3,4].

Most cases of acute diarrhea in adults are of infectious etiology. One of the dilemmas in assessing patients with acute diarrhea is deciding when to perform stool testing and if and when to initiate therapy. The approach to such patients will be reviewed here and generally focuses on distinguishing those infectious etiologies for which treatment is beneficial from other causes (algorithm 1). The evaluation of persistent and chronic diarrhea, which is often of a noninfectious etiology, and specific causes of acute diarrhea and chronic diarrhea are discussed separately. (See "Epidemiology and causes of acute diarrhea in resource-rich countries" and "Approach to the adult with chronic diarrhea in resource-rich settings".)

Diarrhea in travelers in or returning from resource-limited settings and the approach to diarrhea in residents of resource-limited settings are discussed in detail elsewhere. (See "Travelers' diarrhea: Microbiology, epidemiology, and prevention" and "Travelers' diarrhea: Clinical manifestations, diagnosis, and treatment" and "Approach to the adult with acute diarrhea in resource-limited countries".)


Diarrhea is defined as the passage of loose or watery stools, typically at least three times in a 24-hour period [5]. It reflects increased water content of the stool, whether due to impaired water absorption and/or active water secretion by the bowel.

The following definitions have been suggested according to the duration of symptoms:


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Literature review current through: Jul 2017. | This topic last updated: Mar 08, 2017.
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