#3-89E. Navigating the Algorithm: Contemporary Management of Chronic Noninfectious Diarrhea (JAMA, 2026)

Are you struggling to efficiently diagnose the true underlying cause of persistent loose stools in your daily practice? This episode unpacks a comprehensive review on chronic, noninfectious diarrhea, a condition affecting up to 7% of adults, predominantly driven by irritable bowel syndrome with diarrhea (IBS-D) and functional diarrhea. The review outlines a systematic diagnostic approach utilizing non-invasive biomarkers like fecal calprotectin and tissue transglutaminase IgA, alongside targeted lifestyle and pharmacological therapies. The most crucial clinical takeaway is the strong recommendation to perform colonoscopies with random biopsies to rule out microscopic colitis in patients aged 45 or older, or those presenting with alarm symptoms like nocturnal diarrhea. When critically appraising this paper, listeners should note that the authors did not systematically evaluate the quality of the included studies, which may impact the robustness of certain recommendations. Nevertheless, this review is highly valuable for clinicians as it equips them with a clear, evidence-based algorithmic approach to confidently differentiate and manage a highly prevalent gastrointestinal complaint, ultimately streamlining patient care.

Citation: Singh P, Chey WD. Chronic, Noninfectious Diarrhea: A Review. JAMA. 2026. DOI: 10.1001/jama.2026.0872

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.