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lüll Review article: Small intestinal bacterial overgrowth, bile acid malabsorption and gluten intolerance as possible causes of chronic watery diarrhoea Fan X; Sellin JHAliment Pharmacol Ther 2009[May]; 29 (10): 1069-77BACKGROUND: Chronic watery diarrhoea is one of the most common symptoms prompting GI evaluation. Recently, new diagnostic considerations have emerged as possible factors in chronic diarrhoea. AIM: To review available data regarding diagnosis and treatment of chronic diarrhoea with an emphasis on bacterial overgrowth and bile acid malabsorption. METHODS: A systematic search of the English language literature of chronic diarrhoea was performed focused on three possible aetiologies of diarrhoea: small intestinal bacterial overgrowth (SIBO), idiopathic bile salt malabsorption (IBAM), gluten responsive enteropathy. RESULTS: Recent studies suggest that SIBO and bile acid malabsorption may have been underestimated as possible causes of chronic watery diarrhoea. Gluten intolerance with negative coeliac serology is a contentious possible cause of watery diarrhoea, but requires further research before acceptance as an entity. CONCLUSION: In patients with otherwise unexplained chronic watery diarrhoea, small intestinal bacterial overgrowth and bile salt malabsorption should be considered and investigated.|Bacterial Infections/*complications[MESH]|Bile Acids and Salts/*metabolism[MESH]|Chronic Disease[MESH]|Diarrhea/*etiology[MESH]|Glutens/*metabolism[MESH]|Humans[MESH]|Intestine, Small/*microbiology[MESH]|Malabsorption Syndromes/*complications[MESH] |