Recommendations for the diagnosis and management of patients with chronic idiopathic diarrhea: Belgian multidisciplinary expert discussion based on a modified Delphi method

Background: Chronic diarrhea is one of the more common reasons for referral to a gastro-enterologist. Chronic diarrhea can have a broad range of causes, making it a disease entity with a very extensive differential diagnosis. In a proportion of patients, however, a cause for the chronic diarrhea cannot be found and these patients are said to have chronic idiopathic diarrhea (CID).

Methods: A Delphi model was used to establish a diagnostic strategy for patients presenting with chronic diarrhea that maximizes the chance for a positive diagnosis while minimizing the number and invasiveness of the investigations. In addition, the participating experts sought consensus on the different treatment options that can be used in these patients.

Results: While a general consensus was reached on the required diagnostic tests for CID, marked differences were observed on the treatment preferences and strategies for these patients among the different experts. The main reason for this is the lack of solid scientific evidence with the different treatment options in this setting (i.e., most data have been generated in patients with IBS-D).

Conclusion: the Delphi-like process that was used for this initiative proved to be a useful vehicle to fuel discussions on the management of CID among experts with different backgrounds and to sketch the current clinical practice.

Keywords: chronic diarrhea, idiopathic diarrhea, Delphi process, IBS-D.