Indian Society of Gastroenterology Task Force on Diarrhea
National Survey and Practice Guidelines
Survey Form
(Please complete to best of your knowledge and return immediately to co-ordinator)
Name of Respondent:
Affiliation of Respondent:
SECTION I: ACUTE DIARRHEA
EPIDEMIOLOGY
Please provide the following statistics, IF available to you:
1.
2.
3.
4.
5.
No. of cases of acute diarrhea admitted to your hospital annually
…….
Total No. of stool cultures done in your hospital annually
No. of positive stool cultures annually
No. of cases of cholera and shigellosis notified in your district annually
No. of cases of cholera and shigellosis notified in your state annually
DEMOGRAPHY
1. In your practice, do you most commonly see acute diarrhea in:
a. Adults
b. Children
c. Immunosuppressed individuals
d. Other (specify please)
DISEASE PATTERN
1. What is the proportion of the following that you see?
a. Watery diarrhea, non-dehydrating
b. Watery diarrhea, dehydrating
c. Vomiting predominant illness
d. Diarrhea with blood and/or mucus
2. In your practice is most acute diarrhea due to:
a. Bacteria
b. Parasites
c. Viral
d. Drug-induced
e. Other
INVESTIGATIVE APPROACH
1. Please grade the following investigations as (A) essential, (B) should be done if
finance available, (C) necessary occasionally in a clinical context, and (D) only
for research protocols:
a. Stool microscopy for trophozoites
b. Stool microscopy for leucocytes
c. Stool culture for enteric pathogens
d. ELISA or latex agglutination for rotavirus
e. Special tests for diarrheagenic E. coli and newer / emerging pathogens
f. Flexible sigmoidoscopy / colonoscopy
g. Any other test
2. In your opinion, when should blood urea nitrogen and serum electrolytes be done
in a patient with diarrhea?
a. Any diarrhea
b. All watery diarrhea
c. Watery diarrhea with dehydration
d. Only when clinically suspected to have some abnormality
3. If asked to investigate an outbreak of diarrhea, please number the following
approaches in order of importance (if not necessary please strike out):
a. Good clinical history in all involved subjects
b. Identification of risk factors by a team of physicians, epidemiologists and
microbiologists
c. Collection of stool samples in affected individuals
d. Collection of stool samples from non-affected individuals
e. Collection of paired blood samples
TREATMENT STRATEGIES
1. In acute diarrhea, please list against each option below the specific condition(s)
where it would be the important treatment option
a.
b.
c.
d.
Fluid and salt replacement
Dietary alteration
Symptomatic treatment
Antimicrobial therapy
2. Regarding anti-motility drugs, please indicate whether there is:
a. No role in treatment of acute diarrhea
b. Useful in specific situations (please specify):
3. Please tick the management plan shown below that best fits the practice currently
followed by the majority in your hospital/institution:
a.
b.
c.
d.
e.
Shotgun antimicrobial therapy regardless of diagnosis
Ad-hoc empirical therapy based on clinical diagnosis
Empirical therapy based on a well-defined algorithm
Investigation followed by specific therapy
Other (specify)
4. Please tick the management plan shown below that you feel is most cost-effective:
a.
b.
c.
d.
e.
Shotgun antimicrobial therapy regardless of diagnosis
Ad-hoc empirical therapy based on clinical diagnosis
Empirical therapy based on a well-defined algorithm
Investigation followed by specific therapy
Other (specify)
OUTCOME
1. Please provide information on the following. Specific information is preferable,
but informed guesses are acceptable if clearly marked as such:
a) Hospital mortality from acute diarrhea
b) Mortality in the state from acute diarrhea
c) Mortality in specific age groups
a. Infants and young children
b. Elderly
c. Immunosuppressed individuals
d. Other (specify)
d) Number of cases of HUS you have seen following acute diarrhea
e) No. of cases of renal failure seen annually as a result of acute diarrhea
RESEARCH QUESTIONS
1. Please rank the following areas in decreasing order of importance for research in
acute diarrhea:
a)
b)
c)
d)
e)
f)
Molecular epidemiology
Pathophysiology
Health systems research
Operations research
Prevention
Emerging pathogens
2. Please comment on any specific areas that you think are important for research in
acute diarrhea:
SECTION II: CHRONIC DIARRHEA
EPIDEMIOLOGY
Please provide the following statistics, IF available to you:
1. No. of cases of chronic diarrhea seen in your OP or admitted to your hospital
annually
2. No. of cases eventually diagnosed as irritable bowel syndrome
3. No. of cases diagnosed as inflammatory bowel disease
4. No. of cases diagnosed with malabsorption
…….
DEMOGRAPHY
1. In your practice, do you most commonly see chronic diarrhea in:
a. Adults
b. Children
c. Immunosuppressed individuals
d. Other (specify please)
DISEASE PATTERN
1. What is the proportion of the following that you see?
a. Watery diarrhea
b. Steatorrhea
c. Chronic blood and mucus diarrhea
d. Nonspecific syndromes of chronic diarrhea
2. Please list the following in decreasing order of numerical importance as causes of
chronic diarrhea:
a. Inflammatory bowel disease
b. Irritable bowel syndrome
c. Malabsorption syndrome
d. Immunodeficiency with infections
e. Endocrine (specify)
f. Other
3. What is the most common cause of malabsorption syndrome seen in your
institution / hospital? Please give approximate numbers if possible (per year).
a. Parasites
b. Disaccharide intolerance
c. Post-infective malabsorption
d. Small bowel bacterial overgrowth
e. Small bowel lymphoma
f. Tuberculosis
g. Tropical sprue
INVESTIGATIVE APPROACH
1. Malabsorption testing should include (please tick one or more options):
a. Fecal microscopy for fat globules
b. Chemical estimation of fecal fat
c. Xylose absorption
d. Other absorption tests (specify)
e. Breath hydrogen
2. Please list below your indications for colonoscopy in chronic diarrhea:
a. ………………….
b. …………………
c. …………………..
d. …………………..
e. ……………………
f. ……………………..
3. Please list in order of decreasing utility the following radiological tests in chronic
diarrhea:
a. Barium meal follow through
b. Enteroclysis
c. CT scan
d. Ultrasound scan
e. Plain radiograph
f. MRI
4. When investigating chronic diarrhea, which of the following best describes the
practice followed in your institution?
a. Exhaustive investigation for all patients regardless of clinical presentation
b. Ad hoc investigation depending on clinical presentation
c. Structured approach following a written protocol
d. Minimal or no investigation with therapeutic trials
e. Other (specify)
5. How extensively is it necessary to investigate patients with mucus diarrhea and
suspected irritable bowel syndrome?
a. Not necessary to investigate further if fecal occult blood, parasites and
complete blood counts are normal
b. Flexible sigmoidoscopy necessary in most
c. Colonoscopy necessary in most
d. Colonic biopsies are necessary in most
e. Complete work up including small bowel studies necessary
6. Please list below any special tests that you feel should be available in tertiary
referral centers for selected patients with chronic diarrhea:
a. …………………..
b. …………………….
c. ……………………
d. ……………………
e. ……………………
f. …………………….
g. …………………….
TREATMENT STRATEGIES
1. What is the treatment strategy best suited for chronic diarrhea:
a. Investigate all patients before starting therapy
b. Follow syndromic approach to therapy
c. Treat with anti-diarrheal agents, broad spectrum antibiotics and/or antiparasite agents, and investigate if no response
d. Other
2. What is your view on use of anti-motility drugs in chronic diarrhea:
a.
b.
c.
d.
Generally safe and well tolerated
Useful in specific situations (please specify):
Avoid until diagnosis is clear
Other
OUTCOME
1. What percentage of your patients with chronic diarrhea fail to respond to therapy?
…………………………….
.........………………………
……………………………
2. What factors determine non-response to therapy?
……………………………….
………………………………
………………………………
3. What patients would require referral to well equipped tertiary centers for
evaluation?
………………………..
………………………….
…………………………..
RESEARCH QUESTIONS
1. Please list the research questions that you feel are important today in chronic
diarrhea in the Indian scenario:
………………………………..
………………………………..
……………………………….
………………………………..
………………………………
………………………………..