Evidence-Based Clinical Guidelines for Chronic Diarrhea 2023

Digestion. 2024;105(6):480-497. doi: 10.1159/000541121. Epub 2024 Aug 28.

Abstract

The Japan Gastroenterological Association (JGA) published the first version of clinical guidelines for chronic diarrhea 2023. These guidelines describe the definition, classification, diagnostic criteria, diagnostic testing methods, epidemiology, pathophysiology, and treatment of chronic diarrhea, and provide flowcharts for the diagnosis and treatment of chronic diarrhea based on the latest evidence. Treatment for chronic diarrhea begins by distinguishing secondary chronic constipation with a clear etiology, such as drug-induced diarrhea, food-induced diarrhea, systemic disease-associated diarrhea, infection-associated diarrhea, organic disease-associated diarrhea, and bile acid diarrhea. The first line of treatment for chronic diarrhea in the narrow sense, defined in these guidelines as functional diarrhea in routine medical care, is lifestyle modification and dietary therapy. The first medicines to be considered for oral treatment are probiotics for regulating the gut microbiome and anti-diarrheals. Other medications, such as 5HT3 receptor antagonists, anticholinergics, Kampo medicine, psychotherapy, antibiotics, bulking agents, adrenergic agonists, and somatostatin analogs, lack sufficient evidence for their use, highlighting a challenge for future research. This Clinical Guidelines for Chronic Diarrhea 2023, which provides the best clinical strategies for treating chronic diarrhea in Japan, will also be useful for medical treatment worldwide.

Keywords: Chronic diarrhea; Diarrhea-predominant irritable bowel syndrome; Functional diarrhea; Guidelines.

Publication types

  • Practice Guideline

MeSH terms

  • Antidiarrheals / therapeutic use
  • Chronic Disease
  • Diarrhea* / diagnosis
  • Diarrhea* / etiology
  • Diarrhea* / therapy
  • Evidence-Based Medicine* / standards
  • Humans
  • Japan
  • Probiotics* / therapeutic use

Substances

  • Antidiarrheals

Grants and funding

The members of the guidelines development group are relevant professionals from the JGA. The funding body per se did not influence the content of the guidelines.