Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The most common cause of acute diarrhea is infection--viral, bacterial, and
parasitic. Bacteria also can cause acute food poisoning. A third
important cause of acute diarrhea
is starting a new medication.
Viral gastroenteritis
Viral gastroenteritis (viral infection of the stomach and the small
intestine) is the most common cause of acute diarrhea worldwide. Symptoms of
viral gastroenteritis (nausea,
vomiting, abdominal cramps, and diarrhea)
typically last only 48-72 hrs. Unlike bacterial enterocolitis (bacterial
infection of the small intestine and colon), patients with viral gastroenteritis
usually do not have blood or pus in their stools and have little if any fever.
Viral gastroenteritis can occur in a sporadic form (in a single individual) or in an epidemic form (among groups of individuals). Sporadic diarrhea probably is caused by several different viruses and is believed to be spread by person-to-person contact. The most common cause of epidemic diarrhea (for example, on cruise ships) is infection with a family of viruses known as caliciviruses of which the genus
norovirus is the most common (for
example, "Norwalk agent"). The caliciviruses are transmitted by food that is contaminated by sick food-handlers or by person-to-person contact.
Food poisoning
Food poisoning is a brief illness that is caused by toxins produced by
bacteria. The toxins cause abdominal pain
(cramps) and vomiting and also cause the small intestine to secrete large
amounts of water that leads to diarrhea. The symptoms of food poisoning usually
last less than 24 hours. With some bacteria, the toxins are produced in the food
before it is eaten, while with other bacteria, the toxins are produced in the
intestine after the food is eaten.
Symptoms usually appear within several hours
when food poisoning is caused by toxins that are formed in the food before it is
eaten. It takes longer for symptoms to develop when the toxins are formed in the
intestine (because it takes time for the bacteria to produce the toxins).
Therefore, in the latter case, symptoms usually appear after 7-15 hours.
Staphylococcus aureus is an example of a bacterium that produces toxins in
food before it is eaten. Typically, food contaminated with Staphylococcus (such
as salad, meat or sandwiches with mayonnaise) is left un-refrigerated at room
temperature overnight. The Staphylococcal bacteria multiply in the food and
produce toxins. Clostridium perfringens is an example of a bacterium that
multiplies in food (usually canned food), and produces toxins in the small
intestine after the contaminated food is eaten.
Traveler's diarrhea
There are many strains of E. coli bacteria. Most of the E. coli bacteria are normal
inhabitants of the small intestine and colon and are non-pathogenic, meaning
they do not cause disease in the intestines. Nevertheless, these non-pathogenic E. coli
can cause diseases if they spread outside of the intestines, for
example, into the urinary tract (where they cause bladder or kidney infections)
or into the blood stream (sepsis).
Certain strains of E.
coli, however, are pathogenic (meaning they can cause disease in
the small intestine and colon). These pathogenic strains of E. coli
cause diarrhea either by producing toxins (called
enterotoxigenic E.
coli or ETEC) or by invading and inflaming the lining of the small intestine and
the colon and causing enterocolitis (called enteropathogenic E. coli or EPEC).
Traveler's diarrhea usually is caused by an ETEC strain of E. coli that
produces a diarrhea-inducing toxin.
Tourists visiting foreign countries with warm climates and poor sanitation
(Mexico, parts of Africa, etc.) can acquire ETEC by eating contaminated foods
such as fruits, vegetables, seafood, raw meat, water, and ice cubes. Toxins
produced by ETEC cause the sudden onset of diarrhea, abdominal cramps, nausea,
and sometimes vomiting. These symptoms usually occur 3-7 days after arrival in
the foreign country and generally subside within 3 days. Occasionally, other
bacteria or parasites can cause diarrhea in travelers (for example, Shigella,
Giardia,
Campylobacter). Diarrhea caused by these other organisms usually
lasts longer than 3 days.
Bacterial enterocolitis
Disease-causing bacteria usually invade the small intestines and colon and
cause enterocolitis (inflammation of the small intestine and colon). Bacterial
enterocolitis is characterized by signs of inflammation (blood or pus in the
stool, fever) and abdominal pain and diarrhea. Campylobacter jejuni is the most
common bacterium that causes acute enterocolitis in the U.S. Other bacteria that
cause enterocolitis include Shigella, Salmonella, and EPEC. These bacteria
usually are acquired by drinking contaminated water or eating contaminated foods
such as vegetables, poultry, and dairy products.
Enterocolitis caused by the bacterium Clostridium difficile is unusual
because it often is caused by antibiotic treatment. Clostridium difficile is
also the most common nosocomial infection (infection acquired while in the
hospital) to cause diarrhea. Unfortunately, infection also is increasing among
individuals who have neither taken antibiotics or been in the hospital.
E. coli O157:H7 is a strain of E. coli that produces a toxin that causes
hemorrhagic enterocolitis (enterocolitis with bleeding). There was a famous
outbreak of hemorrhagic enterocolitis in the U.S. traced to contaminated ground
beef in hamburgers (hence it is also called hamburger colitis). Approximately 5% of patients infected with E. coli O157:H7, particularly
children, can develop
hemolytic uremic syndrome (HUS), a syndrome that can lead to kidney failure
. Some evidence suggests that prolonged use of anti-diarrhea agents or use of
antibiotics may increase the chance of developing HUS.
Parasites
Parasitic infections are not common causes of diarrhea in the U. S. Infection
with Giardia lamblia occurs among individuals who hike in the
mountains or travel abroad and is transmitted by contaminated drinking water.
Infection with Giardia usually is not associated with inflammation; there is no blood or
pus in the stool and little fever. Infection with amoeba (amoebic
dysentery) usually occurs during travel abroad to undeveloped countries and is
associated with signs of inflammation--blood or pus in the stool and fever.
Cryptosporidiumis
a diarrhea-producing parasite that is spread by contaminated water because it
can survive chlorination. Cyclospora is a diarrhea-producing parasite that has
been associated with contaminated raspberries from Guatemala.
Drugs
Drug-induced diarrhea is very common because many drugs cause diarrhea. The clue
to drug-induced diarrhea is that the diarrhea begins soon after treatment with the drug is
begun. The medications that most frequently cause diarrhea are antacids and
nutritional supplements that contain magnesium. Other classes of medication that
cause diarrhea include:
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Gastroenteritis (viral gastroenteritis, stomach flu) is an infection caused by a variety of viruses that results in vomiting and/or diarrhea. Even though it is often called the "stomach flu," it is not caused by the influenza viruses. Viruses that can cause gastroenteritis (stomach flu) include: rotaviruses, adenoviruses, caliciviruses, astroviruses, Norwalk virus, and a group of Noroviruses. Gastroenteritis is not caused by bacteria. The main symptoms of gastroenteritis include vomiting and watery diarrhea, however, headache, fever, and abdominal cramps (stomach ache) may also be present.
Staphylococcus or Staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a Staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.
Hemorrhoid is an enlarged vein in the walls of the anus and sometimes around the
rectum, usually caused by untreated constipation, but occasionally associated
with chronic diarrhea. If untreated, hemorrhoids can
worsen, protruding from the anus. Also known as piles.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
Diverticulitis is a condition in which diverticuli in the colon rupture. The rupture results in infection in the tissues that surround the colon. Diverticulitis symptoms include: abdominal pain, abdominal cramps, diarrhea, constipation, and bloating. Treatment methods include prescription medications, and in some cases, diverticulitis surgery.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Colon cancer is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Anal itching is the irritation of the skin at the exit of the rectum, known as the anus, accompanied by the desire to scratch. Causes include everything from irritating foods we eat, to certain disease and infections. Treatment options include local anesthetics, vasoconstrictors, protectants, astringents, antiseptics, keratolytics, analgesics, and corticosteroids. If condition persists, a doctor examination may be needed to identify an underlying cause.
An upper respiratory infection is a contagious infection of the structures of the upper respiratory tract, which includes the sinuses, nasal passages, pharynx, and larynx. Common causes of an upper respiratory infection include bacteria and viruses such as rhinoviruses, group A streptococci, influenza, respiratory syncytial, whooping cough, diphtheria, and Epstein-Barre. Examples of symptoms of upper respiratory infection include sneezing, sore throat, cough, fever, and nasal congestion. Treatment of upper respiratory infection are generally with OTC medication and home remedies.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
Clostridium difficile (C. difficile) is a bacterium, and is one of the most common causes of infection of the colon. C. difficile spores are found frequently in hospitals, nursing homes, extended care facilities, and nurseries for newborn infants. They can be found on bedpans, furniture, toilet seats, linens, telephones, stethoscopes, fingernails, rings, floors, infants' rooms, and diaper pails. They even can be carried by pets. Antibiotic-associated (C. difficile) colitis is an infection of the colon caused by C. difficile that occurs primarily among individuals who have been using antibiotics. Treatment for C. difficile colitis hydration, replenishment of electrolyte deficiencies, discontinuing the antibiotic that caused the colitis, and using antibiotics to eradicate the C. difficile bacterium.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
In lactose intolerance, the digestive system cannot digest lactose (the main sugar in milk). Symptoms of lactose intolerance include diarrhea, flatulence, abdominal pain, abdominal bloating, abdominal distention, and nausea. There are several tests to diagnose lactose intolerance. Treatment is generally made with dietary changes, supplements, and adaptation to small amounts of milk.
IBS (irritable bowel syndrome) is a common gastrointestinal disorder involving abnormal gut contractions (motility) characterized by abdominal pain,
bloating, mucous in stools, and irregular bowel habits with alternating diarrhea
and constipation, symptoms that tend to be chronic and to wax and wane over the
years. Treatment options include medication and lifestyle changes such as diet, exercise, and stress management to control symptoms. Also called spastic colitis, mucus colitis, nervous colon syndrome.
Norovirus infection causes stomach flu, or gastroenteritis. It's a very contagious illness with symptoms that include nausea and vomiting, diarrhea, stomach cramps, fever, headache, chills, and muscle aches. Norovirus infection cannot be treated with antibiotics, so treatment focuses on maintaining proper hydration.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Celiac disease is a result of an immune reaction to gluten, a protein found in wheat or related grains and present in many foods that we eat. Celiac disease causes impaired absorption and digestion of nutrients through the small intestine. Signs and symptoms of celiac disease include malabsorbption (diarrhea, foul smelling gas, bloating, and increased amounts of fat in the stool) and malnutrition (weight loss, edema, anemia, bruising easily, neuropathy, and infertility). Treatment for celiac disease is a gluten free diet, and at times if necessary, medications
E. coli is the most common cause of bladder infections. Bladder infection symptoms and signs include frequent urination, burning urination, and foul smelling urine. Mild bladder infections may go away by increasing one's intake of fluid. More severe infections may be treated with a few days of antibiotics.
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. There are many conditions associated with small intestinal bacterial overgrowth, to include: diabetes, scleroderma, Crohn's disease, and others. There is a striking similarity between the symptoms of irritable bowel syndrome and SIBO. It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. Symptoms of SIBO include: excess gas, abdominal bloating, diarrhea, and abdominal pain.
Typhoid fever is an illness caused by the Salmonella typhi bacteria. The illness is contracted by ingesting the bacteria in contaminated water or food. Symptoms include headaches, fever, diarrhea, lethargy, aches and pains, and poor appetite. Treatment focuses on killing the Salmonella bacteria with antibiotics.
The most common food allergies are to eggs, nuts, milk, peanuts, fish, shellfish, strawberries and tomatoes. Symptoms and signs include nausea, vomiting, diarrhea, abdominal pain, itching, hives, eczema, asthma, lightheadedness, and anaphylaxis. Allergy skin tests, RAST, and ELISA tests may be used to diagnose a food allergy. Though dietary avoidance may be sufficient treatment for mild allergies, the use of an Epipen may be necessary for severe food allergies.
Potassium is an essential electrolyte necessary for cell function. Low potassium (hypokalemia) may be caused by diarrhea, vomiting, ileostomy, colon polyps, laxative use, diuretics, elevated corticosteroid levels, renal artery stenosis, and renal tubular acidosis, or other medications. Symptoms of low potassium include weakness, aches, and cramps of the muscles. Treatment is dependant upon the cause of the low potassium (hypokalemia).
Food poisoning is common, but can also be life threatening. The most common form of food poisoning is caused by bacteria and include symptoms such as fever, abdominal pain, diarrhea, nausea and vomiting.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Malaria is an infectious disease transmitted by the bite of an infected Anopheles mosquito. Symptoms of malaria include chills, pain, fever, and sweating. Though mild cases of malaria can be treated with oral medication, severe cases require intravenous drug treatment and fluids.
Hyponatremia is a condition where the level of sodium in the blood is low. Causes of hyponatremia can occur from excess fluid in the body, or a loss of sodium in body fluid. Some of the symptoms of hyponatremia include headache, muscle cramps or spasm, seizures, weakness and confusion. Treatment of hyponatremia depends on the cause.
Pinworm infection is an intestinal infection caused by a pinworm, seatworm, or threadworm. Female pinworms leave the intestine through the anus and deposit eggs on the skin around the anus while a person is asleep. Pinworm infection is the most common worm infection in the US. Symptoms include anal itching or vaginal itching. Pinworm infection is generally spread by inadequate handwashing from infected persons. Treatment is effective after a diagnosis is made with a pinworm test.
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