Gastroenterology

Gastroenterology

Volume 136, Issue 6, May 2009, Pages 1874-1886
Gastroenterology

Diagnosis and Treatment of Acute or Persistent Diarrhea

https://doi.org/10.1053/j.gastro.2009.02.072Get rights and content

Studies of microbial pathogens and the toxins they produce are important for determining the mechanisms by which they cause disease and spread throughout a population. Some bacteria produce secretory enterotoxins (such as cholera toxin or the heat-labile or stable enterotoxins produced by Escherichia coli) that invade cells directly. Others invade cells or produce cytotoxins (such as those produced by Shigella, enteroinvasive E coli, or Clostridium difficile) that damage cells or trigger host responses that cause small or large bowel diseases (such as enteroaggregative or enteropathogenic E coli or Salmonella). Viruses (such as noroviruses and rotaviruses) and protozoa (such as Cryptosporidium, Giardia, or Entamoeba histolytica) disrupt cell functions and cause short- or long-term disease. Much epidemiologic data about these pathogens have been collected from community- and hospital-acquired settings, as well as from patients with traveler's or persistent diarrhea. These studies have led to practical approaches for prevention, diagnosis, and treatment.

Abbreviations used in this paper

cAMP
cyclic adenosine 3′,5′ monophosphate
CDI
Clostridium difficile infection
EAEC
enteroaggregative Escherichia coli
EHEC
enterohemorrhagic Escherichia coli
EIEC
enteroinvasive Escherichia coli
ELISA
enzyme-linked immunoabsorbent assay
EPEC
enteropathogenic Escherichia coli
ETEC
enterotoxigenic Escherichia coli
GI
gastrointestinal
PCR
polymerase chain reaction
PI-IBS
postinfectious irritable bowel syndrome

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Conflicts of interest The authors disclose the following: Dr Guerrant has licensed fecal lactoferrin to Techlab Inc, Blacksburg VA.

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