Acute diarrhea pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]


Diarrhea is a condition of altered intestinal water and electrolyte transport. The pathophysiology of acute diarrhea includes osmotic, secretory, inflammatory types, and diarrhea due to altered motility. Acute diarrhea due to osmotic causes includes osmotic laxatives such as lactose intolerance, antacids, fructose, lactulose, and increased concentration of magnesium, phosphate, and sorbitol, which induce a secretory state. Bacterial infection of the intestine leads to activation of epithelial ion channels with increased secretion of anions. Invasion of the epithelium by various pathogens lead to exotoxin production and enhancement of enterocyte secretion by cytotoxins or intracellular signalling. In case of motility disorders of the gut, rapid transit time delivers fluid secreted during digestion to the distal small bowel or colon. This prevents reabsorption of normally secreted fluid in the small bowel, overwhelming the reabsorptive capacity of the colon.


The exact pathogenesis of acute diarrhea is different for infectious and non-infectious causes. Diarrhea is a condition of altered intestinal water and electrolyte transport. The pathophysiology of acute diarrhea includes osmotic, secretory, inflammatory types, and diarrhea due to altered motility.[1]

Osmotic diarrhea

Stool osmotic gap in cases of osmotic diarrhea is characterized by osmotic gap >125 mOsm/kg. In case of osmotic diarrhea, fasting leads to cessation of diarrhea.

Secretory diarrhea

Secretory diarrhea results from disordered electrolyte transport and is the result of alteration of the absorptive role of the gut and increased secretory capacity. In secretory diarrheas, stool osmotic gap is <50 mOsm/kg and fasting does not lead to diarrhea cessation.

Inflammatory diarrhea

Disruption of the normal colonic epithelial barrier by microorganisms is mainly responsible for inflammatory diarrhea. This disruption may lead to exudative, secretory, or malabsorptive components of inflammatory diarrhea.

Motility disorders causing diarrhea

Both rapid and slow transit time are associated with motility disorders causing diarrhea.

Genetics, Associated conditions, Gross pathology and Microscopic pathology

For the details of the genetics, associated conditions, gross and microscopic pathology of the following causes of acute diarrhea, click the links below.


  1. Sweetser S (2012). "Evaluating the patient with diarrhea: a case-based approach". Mayo Clin Proc. 87 (6): 596–602. doi:10.1016/j.mayocp.2012.02.015. PMC 3538472. PMID 22677080.
  2. Suarez FL, Savaiano DA, Levitt MD (1995). "A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance". N Engl J Med. 333 (1): 1–4. doi:10.1056/NEJM199507063330101. PMID 7776987.
  3. Morris AI, Turnberg LA (1979). "Surreptitious laxative abuse". Gastroenterology. 77 (4 Pt 1): 780–6. PMID 467934.
  4. Pardi DS, Smyrk TC, Tremaine WJ, Sandborn WJ (2002). "Microscopic colitis: a review". Am J Gastroenterol. 97 (4): 794–802. doi:10.1111/j.1572-0241.2002.05595.x. PMID 12003412.
  5. Hammer HF, Santa Ana CA, Schiller LR, Fordtran JS (1989). "Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose". J Clin Invest. 84 (4): 1056–62. doi:10.1172/JCI114267. PMC 329760. PMID 2794043.

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