| Background and AimsThe mechanism of chronic diarrhea is complex and diverse,generally lasting more than 4 weeks,and the stool traits are 6/7 according to Bristol Stool Scale.That is to say,dilute stool or rotten paste stool is the main type.On the basis of chronic diarrhea,intractable diarrhea not only lasts longer,but also shows recurrent attacks and difficult to cure.The incidence of intractable diarrhea of adults is increasing year by year,which will not only lead to a serious decline in the quality of life of patients,seriously affect daily life and work efficiency,serious and even endanger the lives of patients,but also cause serious economic losses.Because of the complex etiology and mechanism in intractable diarrhea of adults,there is no study study on etiology,clinical characteristics,occurrence risk,severity at present.Therefore,the etiology and clinical characteristics of intractable diarrhea of adults were observed and studied in detail.The occurrence and severity of intractable diarrhea of adults also were predicted.ObjectiveThe guide of adult patients diagnosed with intractable diarrhea and non-intractable diarrhea hospitalized in Nanfang Hosipital from December 31,2014 to December 31,2018.Fecal specimens from intractable diarrhea of adults and non-intractable diarrhea from June 31,2018 to December 31,2018 were collected.Contents and Methods1.The information of demography,medical history,basic clinical information,the results of laboratory test,the results of imaging examination,the results of endoscopy and treatment were collected and analyzed by SPSS 21.0(SPSS,Chicago,IL,USA)and RStudio-1.1.463(RStudio,Boston,USA).P<0.05 was defined as statistically significant.2.16SrRNA high-throughput sequencing of collected fecal specimens.Results1.A total of 1201 patients were included,including 746 patients with intractable diarrhea of adults and 455 adults with no intractable diarrhea.In intractable diarrhea of adults,there were 312 cases with gastrointestinal inflammatory diseases(mainly inflammatory bowel disease(IBD),Crohn’s disease(CD)was more than ulcerative colitis(UC).There were 132 patients with gastrointestinal tumor diseases(mainly recurrent multiple intestinal adenomas and multiple intestinal polyps)and 115 patients with gastrointestinal dysfunction(mainly diarrhea-irritable bowel syndrome(IBS-D)and functional diarrhea(FD).And there were 94 cases of dyspepsia and malabsorption syndrome(pancreatic diseases:chronic pancreatitis and hepatogenic diseases:cirrhosis)and 61 cases of infectious diarrhea(mainly intestinal tuberculosis).2.In intractable diarrhea of adults,the incidence of female was more than 60%;More than 80%of intractable diarrhea of adults had complications such as abdominal pain,more than 80%had abnormal blood lipid levels without previous history of hyperlipidemia and taking antilipid drugs.At the same time,more than 50%of the patients complicated with the decrease of serum albumin(ALB),about half of the adult patients with intractable diarrhea had body weight loss(BMI<18.5),mental sleep and other disorders.The main manifestation of dyslipidemia in more than 70%of IBD-associated intractable diarrhea of adult patients was the decrease of simple high-density lipoprotein(HDL)and normal other blood lipid indexes.The mean age of patients with gastrointestinal inflammatory diseases was less than 40 years old(P=0.000).The mean BMI of IDA patients with different etiology were in the normal range,while the mean BMI of patients with gastrointestinal inflammatory diseases was the lowest(P=0.000).More IDA patients with a history of digestive surgery were caused by gastrointestinal tumor diseases,malabsorption and dyspepsia syndrome(P=0.000).More than 80%of IDA patients had no smoking history,more patients with gastrointestinal functional diseases had smoking history and had quit smoking,and more patients with gastrointestinal tumor diseases continued to smoke(P=0.020).The mean level of blood routine,liver function,renal function,electrolyte,CRP,blood lipid and cancer markers were different in patients with IDA of different etiology(P<0.05).The positive rate of fecal occult blood,WBC and RBC were different in different IDA patients(P<0.05).3.Women with gastrointestinal inflammation had a higher incidence of IDA.The incidence of BMI<18.5 was higher than that of other causes.Most of the patients had no obvious family history,no smoking history or had quit smoking.The frequency of defecation was mainly more than 3 times per day,mainly mucus stool,blood stool and so on.The proportion of patients with abdominal pain,fever,weight loss and perianal lesions was very high.Compared with other causes,the patients with gastrointestinal inflammation had obvious anemia,decreased ALB,Ca,HDL and VLDL,also had increased CRP and ESR.4.The etiology of Patients with IDA complicated with abdominal pain(P=0.000),low blood potassium(P=0.030),serum creatinine(P=0.003)were more likely to be IBS-D than FD.5.The etiology of IDA Patients with a duration of less than 1 year(P=0.032),combined with anorexia(P=0.002),fatigue(P=0.013),and mental sleep disorder(P=0.000)were mork likely to be hepatogenic diseases than those with pancreatic diseases or postoperative patients.6.There were significant differences in intestinal microbiology between intractable diarrhea of adults and non-intractable diarrhea.The dominant microbiology in intractable diarrhea of adults were Megasphaera,Lachnospira,Prevotella,Anaerostipes,Leuconostobiaceae,Weissella,Eubacterium and so on.At the phylum-level,in intractabled diarrhea of adults,Firmutes were significantly reduced.At the genus-level,Bacteroides,Blautia,Phascolarctobacterium,Bifidobacterium,Streptococcus were obviously reduced.Fusobacterium,Facelibacterium,Escherichia,Enterobacter,and Lachnoclostridium were obviously increased.7.There were also differences in intestinal microbiology in different etiology with intractable diarrhea of adults.Among the gastrointestinal inflammatory diseases,Proteobacteria,Enterobacteriaceae,Escherichia,Ruminococcus,Fusobacterium,Enterococcus were most important.Eubacterium and unclassified Lachnospiraceae played important roles in the gastrointestinal tumor diseases.Prevotellaceae played an important role in gastrointestinal functional diseases.In the malabsorption and dyspepsia syndrome,Eubacterium were most important.8.There was a specific correlation between intestinal microbiology and blood lipid.Bifidobacterium had a significant correlation with the decrease of HDL in blood lipid.And the decrease of Bifidobacterium content can be used as an important independent risk factor for predicting HDL reduce.9.There were significant differences in intestinal microbiology with different severity of intractable diarrhea.Firmicutes,Bacteroidetes,Fusobacteria,Bacteroides and Blautia were most specific among them.Conclusion1.The main causes of intractable diarrhea of adults included gastrointestinal inflammatory diseases,gastrointestinal tumor diseases,gastrointestinal dysfunction,malaborsorption and dyspepsia syndrome,infectious intractable diarrhea,drug-related intractable diarrhea,systemic diseases,unexplained diarrhea.The incidence of female was higer than that of male.More than 80%of patients with IDA had abnormal hyperlipidemia(increased TG/CHOL/VLDL or decreased HDL).2.The decrease of hemoglobin(Hb)(<130),serum albumin(ALB)(<40)and the increase of high density lipoprotein(HDL)(<1.03),hyperlipidemia can be used as predictors of the risk of intractable diarrhea.Only when HDL was decreased,the risk of intractabled diarrhea in gastrointestinal inflammatory diseases was very high.3.Gastrointestinal inflammatory diseases,decreased hemoglobin(<130),and positive fecal occult blood can be used as predictors of moderate and severe intractable diarrhea of adults.4.There were significant differences in intestinal microbiology between intractable diarrhea and non-intractable diarrhea.The decrease of content in Bifidobacterium can be used as an independent risk factor for the decrease of HDL level.And the decrease of content in Firmicutes and Fusobacteria can be used independent risk facors for moderate and severe intractable diarrhea of adults. |
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