๐ Key Information Summary
- Chronic diarrhoea is defined as loose, frequent stools persisting for >4 weeks; acute diarrhoea (<4 weeks) is managed differently and most commonly infectious or medication-related.
- Initial workup should include a thorough medication review (metformin, PPIs, SSRIs, NSAIDs, colchicine, antibiotics), travel history, dietary history (FODMAPs, lactose, artificial sweeteners), and baseline bloods (FBC, EUC, LFT, CRP, TFT, coeliac serology).
- Stool testing strategy is guided by clinical context: stool microscopy, culture and sensitivity for suspected infectious aetiology; C. difficile toxin PCR if recent antibiotics or healthcare exposure; faecal calprotectin to differentiate inflammatory from functional causes.
- Faecal elastase-1 (<200 ยตg/g) and 72-hour faecal fat (>7 g/day) are first-line tests for pancreatic exocrine insufficiency and fat malabsorption respectively.
- Coeliac disease screening requires total serum IgA plus tissue transglutaminase IgA (tTG-IgA); if IgA-deficient, order deamidated gliadin peptide (DGP) IgG; patients must be on a gluten-containing diet at testing.
- Hyperthyroidism is an under-recognised cause of chronic diarrhoea โ always check TSH; bile acid diarrhoea (BAD) is increasingly recognised and diagnosed via SeHCAT scan or empirical bile acid sequestrant trial.
- Referral to gastroenterology is indicated for persistent unexplained diarrhoea, raised inflammatory markers (CRP/ESR), unintentional weight loss, nocturnal symptoms, rectal bleeding, or suspected organic disease.
- Red-flag features โ age >50 at new symptom onset, nocturnal diarrhoea waking the patient, weight loss >5%, blood/mucus in stool, family history of colorectal cancer or IBD โ warrant urgent colonoscopy.
- In Australia, Aboriginal and Torres Strait Islander peoples have higher rates of infectious gastroenteritis, chronic H. pylori, and environmental enteropathy; early investigation and culturally safe communication are essential.
- Osmotic diarrhoea is suggested by stool osmotic gap >125 mOsm/kg; secretory diarrhoea has a gap <50 mOsm/kg โ this distinction guides further workup.
- Iron deficiency anaemia, folate deficiency, vitamin D deficiency, and hypoalbuminaemia may accompany chronic diarrhoea and should prompt investigation for malabsorption.
- Irritable bowel syndrome (IBS-D) is a diagnosis of exclusion after organic causes have been ruled out; Rome IV criteria should be applied.
Introduction & Australian Epidemiology
Chronic diarrhoea โ defined as the passage of loose or watery stools at least three times daily, or an increase in stool weight to >200 g/day, persisting beyond four weeks โ is one of the most common presentations in Australian primary care. It affects approximately 5โ7% of the adult population at any given time and accounts for a significant burden of specialist gastroenterology referrals nationwide.
The differential diagnosis is broad, spanning functional disorders (predominantly irritable bowel syndrome with diarrhoea, IBS-D), inflammatory bowel disease (Crohn disease and ulcerative colitis), coeliac disease, chronic infections, pancreatic exocrine insufficiency, bile acid malabsorption, medication side effects, endocrine disorders, and less commonly, colorectal neoplasia.
In the Australian context, several epidemiological considerations are particularly relevant:
- Coeliac disease affects approximately 1 in 70 Australians, though only 1 in 5 are diagnosed, making it one of the most common chronic causes of diarrhoea that is frequently missed in primary care.
- Inflammatory bowel disease (IBD) incidence in Australia is among the highest globally, with over 85,000 affected individuals; peak incidence is in the 15โ29 and 60โ69 age groups.
- Clostridioides difficile infection (CDI) rates have risen in Australian hospitals and aged-care facilities, particularly with ribotype 027 and 014/020 strains.
- Aboriginal and Torres Strait Islander Australians experience disproportionately higher rates of gastrointestinal infections, environmental enteropathy, and H. pylori carriage, contributing to chronic diarrhoea in remote communities.
- Bile acid diarrhoea (BAD) is estimated to affect 1โ2% of the adult population and is increasingly recognised as an underdiagnosed cause of chronic watery diarrhoea, particularly post-cholecystectomy.
Medication review is critical. Up to 20% of chronic diarrhoea cases in Australian primary care are drug-related. Commonly implicated agents include metformin, proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), NSAIDs, colchicine, acarbose, magnesium-containing antacids, and angiotensin receptor blockers (especially olmesartan).
Classification & Initial Workup
A systematic approach to chronic diarrhoea begins with distinguishing it from acute diarrhoea and then classifying the likely mechanism to guide targeted investigation.
Acute vs Chronic Diarrhoea
| Feature | Acute Diarrhoea (<4 weeks) | Chronic Diarrhoea (>4 weeks) |
|---|---|---|
| Duration | <4 weeks | >4 weeks |
| Common causes | Infections (viral, bacterial, parasitic), medication, food poisoning | IBS-D, IBD, coeliac disease, bile acid malabsorption, pancreatic insufficiency, chronic infections |
| Initial management | Supportive; stool MCS if fever, blood, or travel; C. difficile if recent antibiotics | Structured diagnostic workup with targeted investigations |
| Key red flags | Dehydration, bloody stool, fever >38.5ยฐC, immunosuppression | Weight loss, nocturnal symptoms, rectal bleeding, age >50 new onset, family history CRC |
Mechanism-Based Classification
| Mechanism | Characteristics | Stool Osmotic Gap | Examples |
|---|---|---|---|
| Osmotic | Improves with fasting; related to ingestion of poorly absorbed solutes | >125 mOsm/kg | Lactose intolerance, sorbitol/mannitol, magnesium laxatives, coeliac disease |
| Secretory | Persists with fasting; large-volume watery stools | <50 mOsm/kg | Bile acid malabsorption, VIPoma, carcinoid, cholera, microscopic colitis |
| Inflammatory | Blood/mucus in stool; elevated CRP, faecal calprotectin | Variable | Crohn disease, ulcerative colitis, diverticulitis, colorectal cancer, radiation proctitis |
| Motility-related | Rapid transit; associated with systemic conditions or medications | Variable | IBS-D, hyperthyroidism, diabetic autonomic neuropathy, post-vagotomy |
| Malabsorptive | Steatorrhoea, weight loss, nutritional deficiencies | >125 mOsm/kg | Pancreatic exocrine insufficiency, coeliac disease, SIBO, short bowel syndrome |
Stool Osmotic Gap Calculation
Formula: Stool osmotic gap = 290 โ 2 ร (stool [Naโบ] + stool [Kโบ]). A gap >125 mOsm/kg suggests osmotic diarrhoea; a gap <50 mOsm/kg suggests secretory diarrhoea. Intermediate values (50โ125) are indeterminate and require further investigation.
Initial Workup โ Baseline Investigations
Every patient presenting with chronic diarrhoea (>4 weeks) should receive the following baseline investigations at first assessment:
Essential
Full blood count (FBC)
Assess for iron deficiency anaemia (low MCV), eosinophilia (parasites, allergy), thrombocytosis (inflammation). MBS Item 65070.
Essential
Urea, electrolytes, creatinine (EUC)
Assess dehydration, renal function, electrolyte derangement (hypokalaemia). MBS Item 66500.
Essential
Liver function tests (LFTs)
Hypoalbuminaemia suggests protein-losing enteropathy or malabsorption. MBS Item 66515.
Essential
C-reactive protein (CRP)
Elevated in IBD, infection, malignancy; normal in functional diarrhoea and coeliac disease. MBS Item 65070.
Essential
Thyroid function tests (TSH ยฑ free T4)
Hyperthyroidism is an under-recognised cause of chronic diarrhoea. MBS Item 66715.
Essential
Coeliac serology (tTG-IgA + total IgA)
Screen all patients with chronic unexplained diarrhoea; must be on gluten-containing diet. MBS Item 66811.
Available
Iron studies, folate, vitamin B12, vitamin D
Assess for malabsorption-related deficiencies. MBS Item 66820 (B12/folate); Iron studies MBS Item 66030.
Available
Faecal calprotectin
Differentiates inflammatory (IBD) from functional (IBS-D) causes; sensitivity >90% for mucosal inflammation. Available through major Australian pathology (Sonic, Douglass Hanly Moir, QML).
Essential History โ The MEDICATE Mnemonic
- M โ Medications (metformin, PPIs, SSRIs, NSAIDs, olmesartan, colchicine, acarbose)
- E โ Eating patterns (FODMAPs, lactose, artificial sweeteners โ sorbitol, mannitol, erythritol)
- D โ Duration and pattern (nocturnal vs daytime, postprandial, fasting)
- I โ Infections and travel history (Giardia, parasites, C. difficile)
- C โ Comorbidities (diabetes, thyroid disease, coeliac disease, IBD, HIV)
- A โ Alarm features (weight loss, blood, nocturnal symptoms, age >50)
- T โ Type and consistency (watery, fatty/bulky, bloody, mucoid)
- E โ Family history (IBD, coeliac disease, colorectal cancer, polyposis syndromes)
Stool Testing Strategy
Stool investigations in chronic diarrhoea should be guided by clinical context rather than ordered reflexively. The testing approach differs based on whether the presentation is subacute (4โ12 weeks) with infectious features, or chronic (>12 weeks) with features suggestive of inflammatory, malabsorptive, or functional aetiology.
Stool Tests โ Indications and Interpretation
| Investigation | Indication | Interpretation | Availability |
|---|---|---|---|
| Stool microscopy, culture & sensitivity (MCS) | Recent travel, acute-on-chronic flare, fever, blood/mucus, immunosuppression | Identifies bacterial pathogens (Salmonella, Shigella, Campylobacter, Yersinia); request specific parasites if travel to endemic area | All Australian pathology labs; MBS Item 69310 |
| C. difficile toxin PCR / GDH + toxin EIA | Recent antibiotics (within 3 months), PPI use, healthcare/hospital contact, aged-care residence | PCR alone is highly sensitive but may detect colonisation; GDH screen + toxin EIA two-step algorithm preferred. Positive toxin = treat. | Available at all major labs; MBS Item 69322 |
| Faecal calprotectin | Suspected IBD vs IBS-D differentiation; elevated CRP; family history of IBD | <50 ยตg/g = low probability of IBD (NPV >95%); 50โ200 = indeterminate (repeat in 4โ6 weeks); >200 = high probability โ refer to GI for colonoscopy | Major Australian labs (Sonic, DHM, QML, PathWest WA); MBS Item 69320 |
| Faecal elastase-1 | Suspected pancreatic exocrine insufficiency (PEI): steatorrhoea, weight loss, chronic alcohol use, pancreatic disease history | <200 ยตg/g = moderate PEI; <100 ยตg/g = severe PEI. Requires formed stool sample (avoid watery stool โ falsely low). Does not require fasting. | Reference labs; MBS Item 69334 |
| 72-hour faecal fat quantification | Suspected fat malabsorption / steatorrhoea when faecal elastase is equivocal | >7 g/day on standard diet (>14 g/day on high-fat diet) = steatorrhoea. Requires 72-hour collection โ patient compliance is often a barrier. | Reference and hospital-based labs; MBS Item 69334 |
| Stool ova, cysts & parasites (OCP) | Travel to endemic areas (SE Asia, Pacific, Africa, Central America), immunosuppression, eosinophilia, MSM, daycare exposure | Giardia lamblia is the most common parasitic cause in Australia; request Giardia-specific antigen test for higher sensitivity; three samples on alternate days improve yield. | All Australian labs; MBS Item 69310 |
| Faecal immunochemical test (FIT) | Suspected colorectal neoplasia; not a primary test for chronic diarrhoea but may be incidental | Positive FIT in context of chronic diarrhoea warrants colonoscopy. Australia's National Bowel Cancer Screening Program uses FIT for population screening from age 50. | All Australian labs; MBS Item 69325 |
| Faecal lactoferrin | Alternative to calprotectin for detecting intestinal inflammation; may be used in conjunction | Elevated in IBD and bacterial gastroenteritis; negative in IBS and viral gastroenteritis. | Available at major labs; MBS Item 69320 |
Stepwise Stool Testing Algorithm
1
All patients
FBC, CRP, coeliac serology (tTG-IgA + total IgA), TFT. If infectious features โ stool MCS + C. difficile PCR.
2
If inflammatory features (elevated CRP, blood/mucus)
Faecal calprotectin. If >200 ยตg/g โ urgent GI referral for colonoscopy. If 50โ200 โ repeat in 4โ6 weeks.
3
If fatty/bulky stools or weight loss
Faecal elastase-1. If <200 ยตg/g โ confirm with 72-hour faecal fat. Initiate pancreatic enzyme replacement therapy (PERT).
4
If travel history, eosinophilia, or risk factors
Stool OCP ร 3 (alternate days) + Giardia antigen. Consider empirical metronidazole if high suspicion for Giardia.
5
If normal results and persistent diarrhoea
Consider bile acid diarrhoea (SeHCAT scan or empirical cholestyramine trial), hydrogen breath test for SIBO, colonoscopy with random biopsies for microscopic colitis, or GI referral.
Important: Do not perform colonoscopy for chronic diarrhoea in patients <45 years without alarm features and with negative faecal calprotectin and normal coeliac serology โ these patients are far more likely to have IBS-D. Apply Rome IV criteria and consider a therapeutic trial first.
Rule-Out Coeliac Disease & Thyroid Disease
Coeliac disease and thyroid dysfunction are two highly prevalent, treatable causes of chronic diarrhoea that should be excluded in every patient presenting with symptoms lasting >4 weeks. Both conditions are frequently underdiagnosed in Australian practice.
Coeliac Disease โ Screening Protocol
Coeliac disease affects approximately 1.4% of the Australian population (1 in 70), with a diagnosed prevalence of only 0.3โ0.4%, suggesting significant underdiagnosis. All patients with chronic unexplained diarrhoea, bloating, weight loss, iron deficiency anaemia, or a first-degree relative with coeliac disease should be screened.
Serological Testing
Essential
Tissue transglutaminase IgA (tTG-IgA)
First-line screening test; sensitivity 93โ98%, specificity 95โ98%. MBS Item 66811.
Essential
Total serum IgA
Must be ordered with tTG-IgA to exclude selective IgA deficiency (present in 2โ3% of coeliac patients); if IgA-deficient, tTG-IgA will be falsely negative. MBS Item 65070.
Available
Deamidated gliadin peptide IgG (DGP-IgG)
Order if total IgA deficiency confirmed. Also useful in children <2 years where tTG-IgA may have lower sensitivity.
Referral
Endoscopic duodenal biopsy (Marsh classification)
Required for definitive diagnosis; gastroenterology referral if serology positive. Up to 4 biopsies from D2 + 1โ2 from D1 bulb. Patient must remain on gluten-containing diet until biopsy completed.
Critical: Patients must be on a gluten-containing diet (โฅ2 slices of bread daily or equivalent) for at least 6 weeks prior to coeliac serology testing. Testing on a gluten-free diet will produce false-negative results and may delay diagnosis by months or years.
Coeliac Disease โ Interpretation Guide
| Result | Interpretation | Next Step |
|---|---|---|
| tTG-IgA elevated, IgA normal | Likely coeliac disease | GI referral for duodenal biopsy (do not start GFD yet) |
| tTG-IgA negative, IgA normal | Coeliac disease unlikely | Consider other diagnoses; retest if high clinical suspicion |
| tTG-IgA negative, IgA deficient | Result uninterpretable (IgA deficiency) | Order DGP-IgG; GI referral |
| tTG-IgA weakly positive (1โ2ร ULN) | Indeterminate โ may be false positive | Confirm with DGP-IgG and/or endomysial antibodies (EMA); GI referral |
Thyroid Disease
Hyperthyroidism accelerates gut motility and can present with chronic diarrhoea, often preceding classical symptoms such as tremor, weight loss, heat intolerance, and palpitations. Hypothyroidism is more commonly associated with constipation but can occasionally cause alternating bowel habits.
Essential
Thyroid stimulating hormone (TSH)
First-line screen for thyroid dysfunction. Suppressed TSH with elevated free T4/T3 = hyperthyroidism. MBS Item 66715.
Available
Free T4 and Free T3
Order if TSH abnormal; confirms overt vs subclinical disease.
Specialist
Thyroid antibodies (anti-TPO, TSH receptor Ab)
To determine aetiology (Graves disease, autoimmune thyroiditis); ordered by endocrinologist.
Bile Acid Diarrhoea (BAD)
Bile acid diarrhoea (also termed bile acid malabsorption) is an increasingly recognised cause of chronic watery diarrhoea, affecting an estimated 1โ2% of the Australian population. It is particularly common after cholecystectomy (up to 20% of post-cholecystectomy patients) and in patients with Crohn disease involving the terminal ileum.
| Classification | Description | Common Causes |
|---|---|---|
| Type 1 (Secondary) | Ileal dysfunction or resection causing impaired bile acid reabsorption | Crohn disease (terminal ileum), ileal resection, radiation enteritis |
| Type 2 (Primary / Idiopathic) | Excess bile acid production without identifiable cause | Idiopathic; may be associated with FGF19 deficiency |
| Type 3 (Associated) | Bile acid dysregulation secondary to other conditions | Post-cholecystectomy, coeliac disease, SIBO, PPI use, chronic pancreatitis |
Diagnosis and Treatment of BAD
- SeHCAT scan (selenium-homocholic acid taurine scan): gold standard; retention <10% at 7 days confirms BAD. Limited availability in Australia (major tertiary centres only).
- Serum 7ฮฑ-hydroxy-4-cholesten-3-one (C4): elevated levels suggest excess bile acid synthesis; available at select reference laboratories.
- Empirical trial of bile acid sequestrant (cholestyramine 4 g once or twice daily for 2โ4 weeks): a therapeutic response supports the diagnosis and is the most practical approach in Australian primary care where SeHCAT is unavailable.
Cholestyramine (Questranยฎ Lite)
Bile acid sequestrant
Adult dose
4 g (1 sachet) PO once or twice daily before meals; titrate up to 4 g TDS if needed
Paediatric dose
240 mg/kg/day in 2โ3 divided doses (specialist guidance)
Duration
Empirical trial of 2โ4 weeks; long-term if confirmed BAD
Key interactions
Take other medications 1 hour before or 4 hours after (impairs absorption of warfarin, thyroxine, iron, fat-soluble vitamins)
Renal adjustment
None required (not absorbed systemically)
PBS status
โ PBS Authority Required โ Authority for symptomatic bile acid malabsorption
When to Refer to Gastroenterology
Most patients with chronic diarrhoea can be effectively evaluated in primary care with a structured diagnostic approach. However, timely gastroenterology referral is essential when specific red-flag features are present or when initial workup is unrevealing.
Referral Indications
| Indication | Urgency | Action |
|---|---|---|
| Rectal bleeding / blood in stool | Urgent | Colonoscopy within 2 weeks; rule out CRC, IBD, angiodysplasia |
| Unintentional weight loss (>5% body weight in 6 months) | Urgent | Colonoscopy + CT abdomen/pelvis; investigate for malignancy, IBD, malabsorption |
| Nocturnal diarrhoea (waking from sleep) | Urgent | Suggests organic cause โ IBD, microscopic colitis, bile acid malabsorption. Urgent colonoscopy with random biopsies. |
| Age >50 with new-onset change in bowel habit | Urgent | Colonoscopy within 30 days; rule out colorectal neoplasia |
| Family history of CRC or hereditary polyposis | Urgent | Colonoscopy per surveillance guidelines; consider genetic referral (Lynch syndrome, FAP) |
| Elevated faecal calprotectin (>200 ยตg/g) | Semi-urgent | Ileocolonoscopy with biopsies to confirm or exclude IBD |
| Elevated inflammatory markers (CRP, ESR) with diarrhoea | Semi-urgent | Investigation for IBD, infection, malignancy; GI consultation |
| Positive coeliac serology | Semi-urgent | Gastroscopy with duodenal biopsy for histological confirmation; dietitian referral |
| Persistent unexplained diarrhoea (>4 weeks, negative initial workup) | Routine | GI consultation for consideration of colonoscopy with random biopsies (microscopic colitis), SeHCAT scan, hydrogen breath test (SIBO), or endocrine evaluation |
| Suspected microscopic colitis | Routine | Colonoscopy with random colonic biopsies (mucosa appears macroscopically normal); typically affects women >60 years with watery non-bloody diarrhoea |
| Suspected pancreatic exocrine insufficiency | Routine | GI/HPB referral for faecal elastase, CT pancreas, EUS if indicated; initiation of PERT |
| Suspected bile acid diarrhoea โ failed empirical cholestyramine | Routine | GI referral for SeHCAT scan (where available) or consideration of alternative bile acid sequestrants (colestipol, colesevelam) |
Do not delay referral for patients with rectal bleeding, weight loss, or nocturnal symptoms. The National Bowel Cancer Screening Program recommends colonoscopy within 30 days of a positive FIT. Australian GPs can access direct-access colonoscopy lists at many public hospitals.
What to Include in the Referral
- Detailed symptom description: duration, frequency, stool consistency (Bristol Stool Scale), presence of blood/mucus, nocturnal vs daytime
- Complete medication list including OTC, supplements, and recent antibiotic use
- Results of all investigations: FBC, EUC, LFTs, CRP, coeliac serology, TFT, faecal calprotectin, stool MCS
- Body weight trajectory (baseline and current)
- Family history of IBD, CRC, coeliac disease, polyposis
- Travel history if relevant
- Previous colonoscopy or gastroscopy reports if available
Special Populations
Pregnancy
Coeliac serology can be performed in pregnancy; tTG-IgA may be mildly elevated in normal pregnancy โ interpret with caution.
Avoid cholestyramine in pregnancy if possible (impairs fat-soluble vitamin absorption including folate); if bile acid diarrhoea suspected, manage with dietary modification and specialist input.
Colonoscopy is generally deferred in pregnancy unless red-flag symptoms are present; consult with obstetric medicine and gastroenterology jointly.
Loperamide (Imodiumยฎ) is Category B3 โ use only if benefit outweighs risk; avoid in first trimester.
Iron deficiency and folate deficiency from malabsorption can compound pregnancy-related anaemia โ supplement proactively.
Paediatrics
Chronic diarrhoea in children <5 years commonly relates to post-infectious diarrhoea, cow's milk protein allergy, coeliac disease, or toddler's diarrhoea (functional).
Coeliac screening: use tTG-IgA + total IgA; DGP-IgG preferred in children <2 years due to lower tTG-IgA sensitivity in this age group.
Faecal calprotectin is naturally elevated in infants <12 months (up to 300 ยตg/g is normal); use age-adjusted reference ranges.
Cystic fibrosis should be considered in any child with failure to thrive, steatorrhoea, and chronic diarrhoea โ sweat test and faecal elastase.
Weight and growth monitoring (percentile tracking) is the most important clinical parameter in paediatric chronic diarrhoea.
Elderly
Medication-related causes are the most common aetiology in patients >65 years; conduct a thorough polypharmacy review.
C. difficile infection is more common and more severe in the elderly, particularly following hospitalisation or aged-care residence. Always test if recent antibiotic use within 3 months.
Microscopic colitis (collagenous and lymphocytic colitis) typically affects women >60 years with chronic watery non-bloody diarrhoea; diagnosis requires colonoscopic biopsies.
Lower threshold for colonoscopy โ age >50 with new-onset symptoms warrants investigation regardless of calprotectin result.
Dehydration risk is higher in the elderly; monitor EUC and ensure adequate oral rehydration.
Renal Impairment
Diarrhoea-induced dehydration can precipitate acute kidney injury (AKI) in patients with pre-existing CKD โ monitor EUC frequently.
Magnesium-containing laxatives and antacids are particularly dangerous in CKD โ always review.
Cholestyramine is not systemically absorbed and does not require renal dose adjustment.
Loperamide does not require renal dose adjustment but use with caution in advanced CKD (sedation risk).
Hepatic Impairment
Hepatic impairment may alter bile acid metabolism; consider bile acid diarrhoea in patients with chronic liver disease, particularly cholestatic conditions (PBC, PSC).
Cholestyramine is used therapeutically in pruritus of cholestasis โ the dose for diarrhoea may overlap with pruritus management.
LFTs may be deranged in coeliac disease (mild transaminitis); do not attribute LFT abnormalities solely to liver disease without coeliac screening.
Immunocompromised
HIV-positive patients have a broad differential: opportunistic infections (Cryptosporidium, Microsporidium, CMV, MAC), HIV enteropathy, and drug-related diarrhoea (PIs, NNRTIs).
Transplant recipients: consider CMV colitis, C. difficile, drug-related diarrhoea (mycophenolate is a very common cause), and post-transplant lymphoproliferative disorder.
Immunosuppressed patients require lower threshold for stool MCS, C. difficile testing, OCP, and colonoscopy.
Biologic agents (anti-TNF, vedolizumab, ustekinumab) used in IBD may paradoxically cause infectious diarrhoea โ always rule out C. difficile before attributing diarrhoea to IBD flare.
Aboriginal and Torres Strait Islander Health
Aboriginal and Torres Strait Islander Australians experience significantly higher rates of gastrointestinal disease, chronic diarrhoea, and associated complications compared with non-Indigenous Australians. Culturally safe, trauma-informed approaches are essential when assessing and managing chronic diarrhoea in this population.
Key recommendation: All Aboriginal and Torres Strait Islander patients presenting with chronic diarrhoea should receive stool MCS, C. difficile testing (if antibiotics within 3 months), Giardia antigen testing, and Strongyloides serology as part of baseline workup. Refer to RHDAustralia guidelines for Strongyloides management.
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