Version May 2024
| Disorder | Clinical clues or characteristics | Evaluation |
| Dietary triggers | ||
| Food protein-induced proctocolitis | Colitis in otherwise healthy infant; usually caused by cow's milk protein in breast milk or formula. | Trial of cow's milk-free diet |
| Food protein-induced enterocolitis syndrome | Diarrhea, vomiting, and vital sign instability immediately following intake of inciting foods. | Allergy evaluation, dietary restrictions |
| Infectious | ||
| Rotavirus, norovirus, cytomegalovirus, enteropathogenic bacteria | Sick contacts, watery or bloody diarrhea. | Stool culture, PCR |
| Postinfectious diarrhea | History of recent acute diarrhea, with ongoing malabsorptive symptoms. | Trial of lactose-free diet |
| Associated with medical illness | ||
| Necrotizing enterocolitis | Prematurity or underlying medical illness. Presents with feeding intolerance, temperature instability, abdominal distention. Pneumatosis intestinalis on plain radiograph. | Abdominal radiograph |
| Short bowel syndrome | Usually due to resection of substantial portions of bowel (eg, because of necrotizing enterocolitis or atresias). Occasionally due to loss of a specific absorptive site (eg, bile acid malabsorption after resection of the terminal ileum). | History of intestinal resection |
| Anatomic defects | ||
| Malrotation with intermittent volvulus | Typically presents with obstructive symptoms and vomiting, but occasionally presents with diarrhea, which may be bloody, and intermittent abdominal pain. | Abdominal radiograph, fluoroscopic UGI/SBFT |
| Hirschsprung disease | Typically presents with constipation and signs of distal obstruction, but occasionally presents with Hirschsprung-associated enterocolitis, a potentially life-threatening illness with a sepsis-like picture including diarrhea or subacute diarrhea with poor weight gain. Hirschsprung disease is particularly common in infants with Down syndrome. | Barium enema, rectal biopsy |
| Congenital intestinal pseudo-obstruction | Impaired intestinal motility without anatomic obstruction, leading to diffuse bowel dilation, abdominal distension, often vomiting and constipation, and sometimes diarrhea. Contrast radiographs often reveal very dilated bowel loops and malrotation (similar to congenital short bowel syndrome). | Fluoroscopic UGI/SBFT |
| Congenital short bowel syndrome | Generalized malabsorptive diarrhea and dilated bowel loops despite lack of abdominal distension, often with bile-stained vomiting and failure to thrive. Contrast radiographs often reveal malrotation (similar to congenital intestinal pseudo-obstruction). | Fluoroscopic UGI/SBFT |
| Congenital diarrheas and enteropathies (CODEs) | ||
Many types; main categories are:
| CODEs are rare genetic disorders that cause malabsorption or other intestinal dysfunction. A CODE is more likely if diarrhea:
| Refer to UpToDate content and algorithm |
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