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© 2016, Jaypee Brothers Medical Publishers

© 2016 by the Indian College of Physicians, Academic Wing of Association of Physicians of India

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First Edition: 2016

It is my proud privilege to write the Foreword for this Monogram: Chronic Diarrhea by Ashis Kumar Saha and Anup Kumar Bhattacharya. Chronic diarrhea is a very commonly encountered problem by all the physicians and general practitioners in their day-to-day practice. Sometimes, diarrhea goes on for weeks, that is when a more serious problem is probably responsible.

Chronic diarrhea is an important public health issue which requires proper attention for every physician practicing modern system of medicine. Our country being a tropical country, the issue is again a serious threat to people living in semi-urban and rural areas lacking in basic healthcare services. In the absence of proper sanitary system prevailing in most parts of our country, our first-hand doctor or the physician of first-contact must have a thorough knowledge in the approach of this common health hazard. The Association of Physicians of India (API) and its academic wing, Indian College of Physicians (ICP), has rightfully chosen to prepare a monograph on this common heath issue.

The two principal functions of our GI tract can be broadly described as—assimilation of nutrients of our body and expulsion of waste products. Our stomach helps in trituration and mixing of bolus followed by propelling of pepsin and hydrochloric acid mixed bolus into the duodenum. The nutritive and absorptive function is done by small intestine. The proximal intestine helps in rapid absorption in presence of pancreatic juice, the ileum is meant for absorption of vitamin B₁₂ and bile acids. The colon prepares the final waste products after absorption of water and thus the final fecal volume is 100–300 mL. The proximal colon mainly helps in absorption of water while distal colon with peristaltic mass action expels the stool.

Chronic diarrhea, a common manifestation of GI diseases, therefore, can be described under the following headings:

Impaired digestion and absorption: Malabsorption syndrome due to intestinal enzyme deficiency, gastric hypersecretory condition–Zollinger-Ellison syndrome, celiac disease, bacterial overgrowth, infectious enteritis, are associated with impaired digestion and/or absorption.

Impaired secretion: Patients with infectious or inflammatory small-intestinal and colonic diseases develop fluid loss due to impaired absorption and/or hypersecretion. Villous adenomas and endocrine neoplasia (VIPOMAS) results in overproduction of the secretory polypeptide.

Impaired gut transit: Rapid propulsions are less common than delayed transit. Rapid transit is noted in hyperthyroidism, irritable bowel syndrome and also in post-vagotomy dumping syndrome.

Immune disorders: Altered gut immune function is noted in celiac disease, Crohn’s disease, ulcerative colitis, infective agents such as bacterial, viral, protozoal, cause subepithelial infiltrates and less mucosal damage.