Abstract
BackgroundGastrointestinal endoscopy is frequently recommended for chronic diarrhea assessment in Western countries, but its benefit in the Southeast Asia region is not well established.MethodsMedical records of consecutive patients undergoing esophagogastroduodenoscopy (EGD), colonoscopy, and small bowel endoscopy for chronic diarrhea from 2008 to 2018 were reviewed. Small bowel endoscopy included push enteroscopy, balloon-assisted enteroscopy (BAE), and video capsule endoscopy (VCE). The diagnostic yield of each endoscopic modality and predictors for positive small bowel endoscopy were analyzed.ResultsA total of 550 patients were included. The mean age was 54 years, and 266 (46.3%) patients were male. The mean hemoglobin and albumin levels were 11.6 g/dL and 3.6 g/dL, respectively. EGD and colonoscopy were performed in 302 and 547 patients, respectively, and the diagnostic yield was 24/302 (7.9%) for EGD and 219/547 (40.0%) for colonoscopy. EGD did not reveal positive findings in any patients with normal colonoscopy. Fifty-one patients with normal EGD and colonoscopy underwent small bowel endoscopy. Push enteroscopy, BAE, and VCE were performed in 28, 21, and 19 patients with a diagnostic yield of 5/28 (17.9%), 14/21 (66.7%), and 8/19 (42.1%), respectively. Significant weight loss, edema, and hypoalbuminemia were independent predictors for the positive yield of small bowel endoscopy.ConclusionColonoscopy was an essential diagnostic tool in identifying the cause of chronic diarrhea in Thai patients, whereas EGD provided some benefits. Small bowel endoscopy should be performed when colonoscopy and EGD were negative, particularly in patients with significant weight loss, edema, and hypoalbuminemia.
Highlights
Chronic diarrhea affects approximately 5% of the Western population [1]
Study design and population We retrospectively reviewed the medical records of consecutive patients aged 18 years or older who underwent EGD and/or colonoscopy to investigate chronic diarrhea at Siriraj Hospital, Bangkok, Thailand, from January 2008 to December 2018
We evaluated consecutive patients with negative EGD and colonoscopy who underwent subsequent small bowel endoscopy, including push enteroscopy (PE), balloon-assisted enteroscopy (BAE), and video capsule endoscopy (VCE) from the same period
Summary
Functional disorders (e.g., irritable bowel syndrome [IBS]) and inflammatory diseases (e.g., inflammatory bowel disease [IBD], microscopic colitis, and celiac disease) are the most common causes of chronic diarrhea in western countries [2, 3]. According to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines, a diagnostic colonoscopy is recommended for the evaluation of chronic unexplained diarrhea [4]. The diagnostic yield of colonoscopy in patients with chronic diarrhea ranges from 18 to 31% in Western countries, and the common diagnoses are IBD or microscopic colitis [2, 3, 5]. Upper gastrointestinal (GI) evaluation for diseases involving the duodenum should be considered in chronic diarrhea patients with negative colonoscopy [4]. Gastrointestinal endoscopy is frequently recommended for chronic diarrhea assessment in Western countries, but its benefit in the Southeast Asia region is not well established
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