The Truth... What is it?

Intestinal problems


It is not at all uncommon for people to "get a bug" and have diarrhea a few days. Provided there is no fever, no serious feeling of being really ill, and no blood passed into the toilet with the bowel movement, one can usually suffer thru without treatment other than maybe an over-the-counter medicine from the store. See a doctor if any of the "sick signs", above. Diarrhea that persists off and on may be something you decide to live with. Unless you are seeing blood or loosing weight, there is probably no absolute necessity to be evaluated by a doctor...unless it causes unmanageable problems. I think that a gastroenterologist will almost always be best at pinpointing the correct diagnosis and setting up a treatment plan. [check ours out] Correct diagnosis my require a colonoscopic exam with biopsies, the tissue biopsies to be sent to a qualified pathologist (such as our group) who often is the one who, under the microscope, is able to see the tell-tale differences between the different diagnoses, below. The key thing is to surely distinguish "inflammatory bowel disease" (IBD), ischemic (blocked circulation) colitis, and collagenous colitis from all others. It is a great advantage if the pathologists and gastroenterologists work locally and closely on cases (as we do).

  1. ACUTE (really "ill") DIARRHEA: gut lining always looks abnormal thru colonoscope and can be true medical emergencies.


     pseudomembraneous colitis: occurs almost always while on antibiotic treatment for some
     other illness; the way it looks thru the colonoscope is usually diagnostic; toxin test on feces and
     biopsies may help cinch the diagnosis.

    acute hemorrhagic: typically from tainted, undercooked meat.

    IBD: IBD-UC and/or IBD-CD may occur apparently suddenly with bleeding or bowel obstruction, respectively.

    ischemic: sometimes with bleeding and almost always with pain and can be severe enough to obstruct or perforate.

    Gut lining looks normal thru colonoscope:

    ulcerative colitis (IBD-UC), early...almost always affects the rectum...biopsy findings may be diagnostic; long-term concern for future cancer.

    Crohn's disease (IBD-CD), early...can cause bowel obstruction & tends not to involve the rectum...biopsy findings may be diagnostic.

    microscopic colitis...biopsy findings may be diagnostic.

    collagenous colitis...usually older women...biopsy findings usually diagnostic.

    nonspecific colitis...minor, non diagnostic biopsy findings.

    irritable bowel syndrome (IBS)...a common disorder; biopsy findings are normal or nonspecifically abnormal.


    Gut lining looks abnormal thru colonoscope:

    infectious colitis...biopsy usually diagnostic.

    ulcerative colitis...may develop precancerous change...biopsy usually diagnostic.

    Crohn's disease...biopsy tends diagnostic.

    ischemic colitis...biopsy usually diagnostic...nearly always women & smoking may aggravate case.

  3. BLOOD IN STOOL (hematochesia), maybe along with loose stools:
    noncancerous colonic polyp...pathology exam determines if cancer or not AND whether it is the type of polyp more closely indicating a constitutional tendency to develop colonic cancer.

    diverticulosis/diverticulitis...biopsy usually not needed.

    internal biopsy.

    ischemic colitis...biopsy diagnostic.

    benign colonic ulcer...biopsy rules out cancer.

    cancer/precancer...biopsy diagnostic.

    abnormal bleeding blood biopsy.

    As you can see, the pathologist's interpretation of the biopsy is crucial to either declare a correct diagnosis, confirm the gastroenterologist's clinical impression, or to rule out or rule in such things as cancer or precancerous (dysplasia) changes. Barium enema and virtual colonoscopy are alternative studies in cases where direct colonoscopy is inadvisable; but, visualization of abnormalities is nowhere near as good as in direct colonoscopy. Our pathology group has much GI information on the group's website [here].

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(posted 3 Sept 1998 [1st update 15 August 1999; review 6 June 2002; latest update 8 February 2004)