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Chapter 040. Diarrhea and Constipation (Part 1)

Harrison's Internal Medicine Chapter 40. Diarrhea and Constipation DIARRHEA AND CONSTIPATION: INTRODUCTION Diarrhea and constipation are exceedingly common and together exact an enormous toll in terms of mortality, morbidity, social inconvenience, loss of work productivity, and consumption of medical resources. Worldwide, 1 billion individuals suffer one or more episodes of acute diarrhea each year. Among the 100 million persons affected annually by acute diarrhea in the United States, nearly half must restrict activities, 10% consult physicians, ~250,000 require hospitalization, and ~5000 die (primarily the elderly). The annual economic burden to society may exceed $20 billion. Acute infectious diarrhea remains one of. | Chapter 040. Diarrhea and Constipation Part 1 Harrison s Internal Medicine Chapter 40. Diarrhea and Constipation DIARRHEA AND CONSTIPATION INTRODUCTION Diarrhea and constipation are exceedingly common and together exact an enormous toll in terms of mortality morbidity social inconvenience loss of work productivity and consumption of medical resources. Worldwide 1 billion individuals suffer one or more episodes of acute diarrhea each year. Among the 100 million persons affected annually by acute diarrhea in the United States nearly half must restrict activities 10 consult physicians 250 000 require hospitalization and 5000 die primarily the elderly . The annual economic burden to society may exceed 20 billion. Acute infectious diarrhea remains one of the most common causes of mortality in developing countries particularly among children accounting for 2-3 million deaths per year. Constipation by contrast is rarely associated with mortality and is exceedingly common in developed countries leading to frequent self-medication and in a third of those to medical consultation. Population statistics on chronic diarrhea and constipation are more uncertain perhaps due to variable definitions and reporting but the frequency of these conditions is also high. United States population surveys put prevalence rates for chronic diarrhea at 2-7 and for chronic constipation at 1219 with women being affected twice as often as men. Diarrhea and constipation are among the most common patient complaints faced by internists and primary care physicians and they account for nearly 50 of referrals to gastroenterologists. Although diarrhea and constipation may present as mere nuisance symptoms at one extreme they can be severe or life-threatening at the other. Even mild symptoms may signal a serious underlying gastrointestinal lesion such as colorectal cancer or systemic disorder such as thyroid disease. Given the heterogeneous causes and potential severity of these common complaints it is .