{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:33:13Z","timestamp":1792114393543,"version":"4.4.0"},"reference-count":91,"publisher":"American Medical Association (AMA)","issue":"14","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,4,14]]},"abstract":"<jats:sec id=\"ab-jrv260002-1\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Chronic diarrhea is defined as loose or watery stools lasting longer than 4 weeks and affects approximately 6% to 7% of adults in the US. More than 90% of patients with chronic diarrhea have a noninfectious etiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-jrv260002-2\">\n                    <jats:title>Observations<\/jats:title>\n                    <jats:p>\n                      The most common causes of chronic, noninfectious diarrhea are irritable bowel syndrome with diarrhea (IBS-D) and functional diarrhea. IBS-D typically presents with recurrent abdominal pain relieved or worsened after defecation. Functional diarrhea is a condition in which more than 25% of bowel movements in the preceding 3 months are loose or watery, but it is not associated with significant abdominal pain. Chronic diarrhea due to a small-bowel source, such as celiac disease or small intestinal bacterial overgrowth, is typically associated with large-volume diarrhea and weight loss, with or without steatorrhea. Celiac disease is an autoimmune condition defined by enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals, and small intestinal bacterial overgrowth is characterized by excessive bacteria in the small bowel. Chronic diarrhea due to colon pathology, such as bile acid diarrhea and microscopic colitis, typically presents with frequent, low-volume stools, with or without urgency and excess mucus. Bile acid diarrhea is characterized by excess bile acids in the colon, and microscopic colitis is characterized by chronic inflammation on colon biopsies despite normal endoscopic appearance. Evaluation of chronic diarrhea includes serological testing for celiac disease (tissue transglutaminase immunoglobulin A, along with total immunoglobulin A) and stool testing for fecal calprotectin to evaluate for inflammatory bowel disease. Patients with gastrointestinal bleeding, unexplained weight loss, 45 years or older, nocturnal diarrhea, steatorrhea, and\/or iron deficiency anemia should undergo colonoscopy to evaluate for colorectal cancer as well as upper endoscopy. During colonoscopy, random biopsies are recommended to evaluate for microscopic colitis, which affects 13% of patients with chronic diarrhea. If evaluation does not identify a cause of chronic diarrhea, likely diagnoses are IBS-D or functional diarrhea and the patient should be treated with lifestyle modification, such as regularly scheduled meals, exercise, intake of at least 8 cups of noncaffeinated fluids daily, limiting caffeine to 3 cups or fewer daily, and avoiding alcohol and carbonated beverages. For general treatment of chronic diarrhea, dietary modifications, such as consuming a diet low in fermentable oligosaccharides (legumes, wheat, onions, garlic), disaccharides (lactose), and monosaccharides (fructose), and polyols (sorbitol, mannitol), or medications, such as opiate agonists (loperamide), anticholinergics (hyoscyamine, dicyclomine), or 5-hydroxytryptamine 3 receptor (5-HT\n                      <jats:sub>3<\/jats:sub>\n                      ) antagonists (ondansetron), can be prescribed. These therapies typically improve diarrhea in 50% to 80% of patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-jrv260002-3\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>\n                      The most common causes of chronic, noninfectious diarrhea include IBS-D and functional diarrhea. Diagnostic testing should include consideration of celiac disease, inflammatory bowel disease, and microscopic colitis. Empiric therapies for chronic diarrhea include lifestyle and dietary modifications and medications, including opiate agonists, anticholinergics, and 5-HT\n                      <jats:sub>3<\/jats:sub>\n                      antagonists.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jama.2026.0872","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T16:00:20Z","timestamp":1772467220000},"page":"1250","source":"Crossref","is-referenced-by-count":11,"title":["Chronic, Noninfectious Diarrhea"],"prefix":"10.1001","volume":"335","author":[{"given":"Prashant","family":"Singh","sequence":"first","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil M.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William D.","family":"Chey","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"4","key":"jrv260002r1","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1038\/ajg.2018.24","article-title":"Demographic and dietary associations of chronic diarrhea in a representative sample of adults in the United States.","volume":"113","author":"Singh","year":"2018","journal-title":"Am J Gastroenterol"},{"issue":"4","key":"jrv260002r2","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1038\/ajg.2010.55","article-title":"The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial.","volume":"105","author":"Chey","year":"2010","journal-title":"Am J Gastroenterol"},{"issue":"7","key":"jrv260002r3","doi-asserted-by":"publisher","first-page":"816","DOI":"10.3109\/00365521.2015.1007079","article-title":"Prevalence of organic disease at colonoscopy in patients with symptoms compatible with irritable bowel syndrome: cross-sectional survey.","volume":"50","author":"Patel","year":"2015","journal-title":"Scand J Gastroenterol"},{"issue":"1","key":"jrv260002r4","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1038\/ajg.2016.466","article-title":"Screening for celiac disease in irritable bowel syndrome: an updated systematic review and meta-analysis.","volume":"112","author":"Irvine","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"jrv260002r5","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.02.031","article-title":"Bowel disorders.","author":"Mearin","year":"2016","journal-title":"Gastroenterology"},{"issue":"5","key":"jrv260002r6","doi-asserted-by":"publisher","first-page":"1262","DOI":"10.1053\/j.gastro.2019.12.021","article-title":"Prevalence of Rome IV functional bowel disorders among adults in the United States, Canada, and the United Kingdom.","volume":"158","author":"Palsson","year":"2020","journal-title":"Gastroenterology"},{"issue":"1","key":"jrv260002r7","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1053\/j.gastro.2020.04.014","article-title":"Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation global study.","volume":"160","author":"Sperber","year":"2021","journal-title":"Gastroenterology"},{"issue":"6","key":"jrv260002r8","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1136\/gutjnl-2015-311240","article-title":"The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review.","volume":"66","author":"Sperber","year":"2017","journal-title":"Gut"},{"key":"jrv260002r9","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.jad.2023.10.111","article-title":"Association of major depressive disorder and increased risk of irritable bowel syndrome: a population-based cohort study and a two-sample Mendelian randomization study in the UK biobank.","volume":"345","author":"Wang","year":"2024","journal-title":"J Affect Disord"},{"issue":"9","key":"jrv260002r10","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1038\/s41395-018-0208-3","article-title":"Long-term gastrointestinal consequences are frequent following sporadic acute infectious diarrhea in a tropical country: a prospective cohort study.","volume":"113","author":"Rahman","year":"2018","journal-title":"Am J Gastroenterol"},{"key":"jrv260002r11","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1146\/annurev.genet.37.110801.143820","article-title":"Genetics of lactase persistence and lactose intolerance.","volume":"37","author":"Swallow","year":"2003","journal-title":"Annu Rev Genet"},{"issue":"4","key":"jrv260002r12","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1093\/ajcn\/48.4.1142","article-title":"The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance.","volume":"48","author":"Scrimshaw","year":"1988","journal-title":"Am J Clin Nutr"},{"issue":"5","key":"jrv260002r13","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1016\/j.cgh.2021.06.027","article-title":"The epidemiology of microscopic colitis in Olmsted County, Minnesota: population-based study from 2011 to 2019.","volume":"20","author":"Tome","year":"2022","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"12","key":"jrv260002r14","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1093\/ecco-jcc\/jjaa108","article-title":"Incidence and prevalence of microscopic colitis between 2001 and 2016: a Danish nationwide cohort study.","volume":"14","author":"Weimers","year":"2020","journal-title":"J Crohns Colitis"},{"issue":"4","key":"jrv260002r15","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1136\/gut.2006.105890","article-title":"The epidemiology of microscopic colitis: a population based study in Olmsted County, Minnesota.","volume":"56","author":"Pardi","year":"2007","journal-title":"Gut"},{"issue":"1","key":"jrv260002r16","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.cgh.2007.10.031","article-title":"Microscopic colitis-defining incidence rates and risk factors: a population-based study.","volume":"6","author":"Williams","year":"2008","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"2","key":"jrv260002r17","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1002\/ueg2.12374","article-title":"Celiac disease and risk of microscopic colitis: a nationwide population-based matched cohort study.","volume":"11","author":"Bergman","year":"2023","journal-title":"United European Gastroenterol J"},{"issue":"5","key":"jrv260002r18","doi-asserted-by":"publisher","first-page":"e43","DOI":"10.1097\/MCG.0b013e31829f56e7","article-title":"A prospective assessment of the natural course of the exocrine pancreatic function in patients with a pancreatic head tumor.","volume":"48","author":"Sikkens","year":"2014","journal-title":"J Clin Gastroenterol"},{"issue":"6","key":"jrv260002r19","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/j.cgh.2017.06.037","article-title":"Global prevalence of celiac disease: systematic review and meta-analysis.","volume":"16","author":"Singh","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"11","key":"jrv260002r20","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1038\/ajg.2015.296","article-title":"Risk of celiac disease in the first- and second-degree relatives of patients with celiac disease: a systematic review and meta-analysis.","volume":"110","author":"Singh","year":"2015","journal-title":"Am J Gastroenterol"},{"issue":"10","key":"jrv260002r21","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1111\/apt.12973","article-title":"Systematic review with meta-analysis: associations between coeliac disease and type 1 diabetes.","volume":"40","author":"Elfstr\u00f6m","year":"2014","journal-title":"Aliment Pharmacol Ther"},{"issue":"7","key":"jrv260002r22","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1089\/thy.2016.0108","article-title":"Prevalence of celiac disease in patients with autoimmune thyroid disease: a meta-analysis.","volume":"26","author":"Roy","year":"2016","journal-title":"Thyroid"},{"issue":"1","key":"jrv260002r23","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.pan.2017.11.012","article-title":"A population-based evaluation of the natural history of chronic pancreatitis.","volume":"18","author":"Machicado","year":"2018","journal-title":"Pancreatology"},{"issue":"5","key":"jrv260002r24","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1016\/j.jpeds.2014.01.022","article-title":"Pancreatic enzyme replacement therapy dosing and nutritional outcomes in children with cystic fibrosis.","volume":"164","author":"Haupt","year":"2014","journal-title":"J Pediatr"},{"issue":"12","key":"jrv260002r25","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1016\/j.cgh.2009.06.031","article-title":"Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis.","volume":"7","author":"Ford","year":"2009","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"jrv260002r26","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1136\/gut.35.1.90","article-title":"Bile acid malabsorption in Crohn\u2019s disease and indications for its assessment using SeHCAT.","volume":"35","author":"Nyhlin","year":"1994","journal-title":"Gut"},{"issue":"3","key":"jrv260002r27","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1053\/j.gastro.2021.11.019","article-title":"Rome Foundation clinical diagnostic criteria for disorders of gut-brain interaction.","volume":"162","author":"Drossman","year":"2022","journal-title":"Gastroenterology"},{"issue":"7","key":"jrv260002r28","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1038\/ajg.2012.131","article-title":"Effect of gender on prevalence of irritable bowel syndrome in the community: systematic review and meta-analysis.","volume":"107","author":"Lovell","year":"2012","journal-title":"Am J Gastroenterol"},{"issue":"9","key":"jrv260002r29","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1038\/s41395-018-0195-4","article-title":"A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome.","volume":"113","author":"Dionne","year":"2018","journal-title":"Am J Gastroenterol"},{"issue":"1","key":"jrv260002r30","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1136\/gutjnl-2018-318160","article-title":"Efficacy of pharmacological therapies in patients with IBS with diarrhoea or mixed stool pattern: systematic review and network meta-analysis.","volume":"69","author":"Black","year":"2020","journal-title":"Gut"},{"issue":"5","key":"jrv260002r31","doi-asserted-by":"publisher","first-page":"S-111","DOI":"10.1016\/S0016-5085(24)00748-0","article-title":"Prevalence of disaccharidase deficiency in adults with irritable bowel syndrome and functional diarrhea: analysis from a multicenter, prospective US study.","volume":"166","author":"Eswaran","year":"2024","journal-title":"Gastroenterology"},{"issue":"1","key":"jrv260002r32","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.cgh.2019.08.062","article-title":"Canadian Association of Gastroenterology clinical practice guideline on the management of bile acid diarrhea.","volume":"18","author":"Sadowski","year":"2020","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"12","key":"jrv260002r33","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.20495","article-title":"Frequency of celiac disease in patients with chronic diarrhea.","volume":"13","author":"Panezai","year":"2021","journal-title":"Cureus"},{"issue":"12","key":"jrv260002r35","doi-asserted-by":"publisher","first-page":"1824","DOI":"10.1038\/ajg.2016.434","article-title":"A randomized controlled trial comparing the low FODMAP diet vs modified NICE guidelines in US adults with IBS-D.","volume":"111","author":"Eswaran","year":"2016","journal-title":"Am J Gastroenterol"},{"issue":"12","key":"jrv260002r36","doi-asserted-by":"publisher","first-page":"1709","DOI":"10.7326\/ANNALS-25-01519","article-title":"The Mediterranean diet for irritable bowel syndrome: a randomized clinical trial.","volume":"178","author":"Bamidele","year":"2025","journal-title":"Ann Intern Med"},{"issue":"14","key":"jrv260002r37","doi-asserted-by":"publisher","first-page":"6089","DOI":"10.7314\/APJCP.2015.16.14.6089","article-title":"Seven-day bismuth-based quadruple therapy as an initial treatment for Helicobacter pylori infection in a high metronidazole resistant area.","volume":"16","author":"Vilaichone","year":"2015","journal-title":"Asian Pac J Cancer Prev"},{"issue":"9","key":"jrv260002r38","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1080\/00365521.2024.2381694","article-title":"Opium tincture has anti-propulsive effects in patients with chronic diarrhea: a randomized, placebo-controlled, and cross-over trial.","volume":"59","author":"Okdahl","year":"2024","journal-title":"Scand J Gastroenterol"},{"issue":"1","key":"jrv260002r39","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1056\/NEJMoa1004409","article-title":"Rifaximin therapy for patients with irritable bowel syndrome without constipation.","volume":"364","author":"Pimentel","year":"2011","journal-title":"N Engl J Med"},{"issue":"3","key":"jrv260002r40","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1056\/NEJMoa1505180","article-title":"Eluxadoline for irritable bowel syndrome with diarrhea.","volume":"374","author":"Lembo","year":"2016","journal-title":"N Engl J Med"},{"issue":"10414","key":"jrv260002r41","doi-asserted-by":"publisher","first-page":"1773","DOI":"10.1016\/S0140-6736(23)01523-4","article-title":"Amitriptyline at low-dose and titrated for irritable bowel syndrome as second-line treatment in primary care (ATLANTIS): a randomised, double-blind, placebo-controlled, phase 3 trial.","volume":"402","author":"Ford","year":"2023","journal-title":"Lancet"},{"issue":"1","key":"jrv260002r42","doi-asserted-by":"publisher","first-page":"28","DOI":"10.5056\/jnm24084","article-title":"Efficacy of amitriptyline in irritable bowel syndrome: a systematic review and meta-analysis.","volume":"31","author":"Iqbal","year":"2025","journal-title":"J Neurogastroenterol Motil"},{"issue":"1","key":"jrv260002r43","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1177\/2050640620951905","article-title":"European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations.","volume":"9","author":"Miehlke","year":"2021","journal-title":"United European Gastroenterol J"},{"issue":"7","key":"jrv260002r44","doi-asserted-by":"publisher","first-page":"3108","DOI":"10.1007\/s10620-021-07162-4","article-title":"Clinical characteristics and treatment response in microscopic colitis based on age at diagnosis: a multicenter retrospective study.","volume":"67","author":"Kamboj","year":"2022","journal-title":"Dig Dis Sci"},{"issue":"1","key":"jrv260002r45","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1186\/s12876-022-02438-z","article-title":"Nonsteroidal anti-inflammatory drug exposure and the risk of microscopic colitis.","volume":"22","author":"Yen","year":"2022","journal-title":"BMC Gastroenterol"},{"issue":"9","key":"jrv260002r46","doi-asserted-by":"publisher","DOI":"10.14309\/ctg.0000000000000071","article-title":"Long-term natural history of microscopic colitis: a population-based cohort.","volume":"10","author":"Loreau","year":"2019","journal-title":"Clin Transl Gastroenterol"},{"issue":"17","key":"jrv260002r47","doi-asserted-by":"publisher","first-page":"1738","DOI":"10.1001\/jama.2010.549","article-title":"Diagnostic testing for celiac disease among patients with abdominal symptoms: a systematic review.","volume":"303","author":"van der Windt","year":"2010","journal-title":"JAMA"},{"issue":"1","key":"jrv260002r48","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1111\/j.1365-2036.2009.04110.x","article-title":"Meta-analysis: deamidated gliadin peptide antibody and tissue transglutaminase antibody compared as screening tests for coeliac disease.","volume":"31","author":"Lewis","year":"2010","journal-title":"Aliment Pharmacol Ther"},{"issue":"7","key":"jrv260002r49","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1136\/gutjnl-2012-302196","article-title":"Kinetics of the histological, serological and symptomatic responses to gluten challenge in adults with coeliac disease.","volume":"62","author":"Leffler","year":"2013","journal-title":"Gut"},{"issue":"2","key":"jrv260002r50","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1097\/MPG.0b013e318216f2e5","article-title":"Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report.","volume":"54","author":"Giersiepen","year":"2012","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"5","key":"jrv260002r51","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1111\/his.12592","article-title":"Histology of microscopic colitis\u2014review with a practical approach for pathologists.","volume":"66","author":"Langner","year":"2015","journal-title":"Histopathology"},{"issue":"12","key":"jrv260002r52","doi-asserted-by":"publisher","first-page":"2070","DOI":"10.1002\/1873-3468.13064","article-title":"Metabolism of hydrogen gases and bile acids in the gut microbiome.","volume":"592","author":"Hylemon","year":"2018","journal-title":"FEBS Lett"},{"issue":"5","key":"jrv260002r53","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1038\/ajg.2017.46","article-title":"Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American consensus.","volume":"112","author":"Rezaie","year":"2017","journal-title":"Am J Gastroenterol"},{"issue":"1","key":"jrv260002r54","doi-asserted-by":"publisher","first-page":"16","DOI":"10.5056\/jnm19113","article-title":"Breath tests for the non-invasive diagnosis of small intestinal bacterial overgrowth: a systematic review with meta-analysis.","volume":"26","author":"Losurdo","year":"2020","journal-title":"J Neurogastroenterol Motil"},{"issue":"8","key":"jrv260002r55","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1016\/j.cgh.2018.01.027","article-title":"Diagnostic performance of measurement of fecal elastase-1 in detection of exocrine pancreatic insufficiency: systematic review and meta-analysis.","volume":"16","author":"Vanga","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"3","key":"jrv260002r56","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1016\/j.cgh.2024.08.026","article-title":"Update on the epidemiology and management of microscopic colitis.","volume":"23","author":"Peery","year":"2025","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"jrv260002r57","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1093\/ajcn\/85.1.160","article-title":"A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease.","volume":"85","author":"Catassi","year":"2007","journal-title":"Am J Clin Nutr"},{"issue":"1","key":"jrv260002r58","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1111\/jgh.16808","article-title":"Prevalence and etiologies of non-responsive celiac disease: a systematic review and meta-analysis.","volume":"40","author":"Aggarwal","year":"2025","journal-title":"J Gastroenterol Hepatol"},{"issue":"6","key":"jrv260002r59","doi-asserted-by":"publisher","first-page":"1412","DOI":"10.1038\/ajg.2010.10","article-title":"Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet.","volume":"105","author":"Rubio-Tapia","year":"2010","journal-title":"Am J Gastroenterol"},{"issue":"9","key":"jrv260002r60","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1111\/apt.12684","article-title":"Systematic review: the management of chronic diarrhoea due to bile acid malabsorption.","volume":"39","author":"Wilcox","year":"2014","journal-title":"Aliment Pharmacol Ther"},{"issue":"4","key":"jrv260002r61","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1002\/jcph.6154","article-title":"Efficacy of bile acid sequestrants in the treatment of bile acid diarrhea: a meta-analysis of randomized controlled trials.","volume":"65","author":"Soares","year":"2025","journal-title":"J Clin Pharmacol"},{"issue":"11","key":"jrv260002r62","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003575.pub6","article-title":"Interventions for treating collagenous colitis.","volume":"11","author":"Kafil","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"jrv260002r63","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1053\/j.gastro.2023.07.007","article-title":"AGA clinical practice update on the epidemiology, evaluation, and management of exocrine pancreatic insufficiency: expert review.","volume":"165","author":"Whitcomb","year":"2023","journal-title":"Gastroenterology"},{"issue":"2","key":"jrv260002r64","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1097\/01.mpa.0000226884.32957.5e","article-title":"The effects of oral pancreatic enzymes (Creon 10 capsule) on steatorrhea: a multicenter, placebo-controlled, parallel group trial in subjects with chronic pancreatitis.","volume":"33","author":"Safdi","year":"2006","journal-title":"Pancreas"},{"issue":"5","key":"jrv260002r65","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1111\/apt.13928","article-title":"Systematic review with meta-analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth.","volume":"45","author":"Gatta","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"issue":"12","key":"jrv260002r66","doi-asserted-by":"publisher","first-page":"1875","DOI":"10.1002\/ibd.20977","article-title":"Defining clinical criteria for clinical remission and disease activity in collagenous colitis.","volume":"15","author":"Hjortswang","year":"2009","journal-title":"Inflamm Bowel Dis"},{"issue":"7","key":"jrv260002r67","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006096.pub4","article-title":"Interventions for treating lymphocytic colitis.","volume":"7","author":"Chande","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"jrv260002r68","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1111\/apt.18373","article-title":"Meta-analysis: global prevalence of coeliac disease in type 1 diabetes.","volume":"61","author":"Karimzadhagh","year":"2025","journal-title":"Aliment Pharmacol Ther"},{"issue":"4","key":"jrv260002r69","doi-asserted-by":"publisher","first-page":"S33","DOI":"10.1053\/j.gastro.2005.02.013","article-title":"Genetic testing: who should do the testing and what is the role of genetic testing in the setting of celiac disease?","volume":"128","author":"Liu","year":"2005","journal-title":"Gastroenterology"},{"issue":"12","key":"jrv260002r70","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1001\/jama.2016.10395","article-title":"Screening for celiac disease: evidence report and systematic review for the US Preventive Services Task Force.","volume":"317","author":"Chou","year":"2017","journal-title":"JAMA"},{"issue":"10","key":"jrv260002r71","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1097\/MCG.0b013e31824b2277","article-title":"Immunoglobulin A deficiency in celiac disease.","volume":"46","author":"Chow","year":"2012","journal-title":"J Clin Gastroenterol"},{"issue":"1","key":"jrv260002r72","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1056\/NEJMoa2032441","article-title":"A randomized trial of a transglutaminase 2 inhibitor for celiac disease.","volume":"385","author":"Schuppan","year":"2021","journal-title":"N Engl J Med"},{"issue":"8","key":"jrv260002r73","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1016\/j.arcped.2022.08.005","article-title":"Estimating the prevalence of congenital disaccharidase deficiencies using allele frequencies from gnomAD.","volume":"29","author":"de Leusse","year":"2022","journal-title":"Arch Pediatr"},{"issue":"2","key":"jrv260002r74","doi-asserted-by":"publisher","first-page":"283","DOI":"10.4292\/wjgpt.v7.i2.283","article-title":"Disaccharidase activity in children undergoing esophagogastroduodenoscopy: a systematic review.","volume":"7","author":"Daileda","year":"2016","journal-title":"World J Gastrointest Pharmacol Ther"},{"issue":"2","key":"jrv260002r75","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1007\/s10620-019-05780-7","article-title":"Sucrase-isomaltase deficiency as a potential masquerader in irritable bowel syndrome.","volume":"65","author":"Kim","year":"2020","journal-title":"Dig Dis Sci"},{"issue":"3","key":"jrv260002r76","doi-asserted-by":"publisher","first-page":"384","DOI":"10.5056\/jnm19167","article-title":"Prevalence of disaccharidase deficiency in adults with unexplained gastrointestinal symptoms.","volume":"26","author":"Viswanathan","year":"2020","journal-title":"J Neurogastroenterol Motil"},{"issue":"4","key":"jrv260002r77","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1111\/j.1365-2036.2011.04962.x","article-title":"Meta-analysis: the diagnostic accuracy of lactose breath hydrogen or lactose tolerance tests for predicting the North European lactase polymorphism C\/T-13910.","volume":"35","author":"Marton","year":"2012","journal-title":"Aliment Pharmacol Ther"},{"issue":"4","key":"jrv260002r78","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1038\/sj.ejcn.1602098","article-title":"Effect of exogenous beta-galactosidase in patients with lactose malabsorption and intolerance: a crossover double-blind placebo-controlled study.","volume":"59","author":"Montalto","year":"2005","journal-title":"Eur J Clin Nutr"},{"issue":"1","key":"jrv260002r79","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1002\/jgh3.12463","article-title":"Effect of lactase on symptoms and hydrogen breath levels in lactose intolerance: a crossover placebo-controlled study.","volume":"5","author":"Baijal","year":"2020","journal-title":"JGH Open"},{"issue":"2","key":"jrv260002r80","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1097\/01.mpa.0000437324.52598.ee","article-title":"Smoking as a risk factor for complications in chronic pancreatitis.","volume":"43","author":"Luaces-Regueira","year":"2014","journal-title":"Pancreas"},{"issue":"2","key":"jrv260002r81","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1097\/MPA.0000000000000721","article-title":"Pancreatic insufficiency secondary to tobacco exposure: a controlled cross-sectional evaluation.","volume":"46","author":"Raphael","year":"2017","journal-title":"Pancreas"},{"issue":"7","key":"jrv260002r82","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1080\/003655201300192058","article-title":"Faecal elastase-1: lyophilization of stool samples prevents false low results in diarrhoea.","volume":"36","author":"Fischer","year":"2001","journal-title":"Scand J Gastroenterol"},{"issue":"5","key":"jrv260002r83","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1111\/j.1365-2036.2012.05202.x","article-title":"Randomised clinical trial: the efficacy and safety of pancreatin enteric-coated minimicrospheres (Creon 40000 MMS) in patients with pancreatic exocrine insufficiency due to chronic pancreatitis\u2014a double-blind, placebo-controlled study.","volume":"36","author":"Thorat","year":"2012","journal-title":"Aliment Pharmacol Ther"},{"issue":"10","key":"jrv260002r84","doi-asserted-by":"publisher","first-page":"2276","DOI":"10.1038\/ajg.2010.201","article-title":"Pancrelipase delayed-release capsules (CREON) for exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery: a double-blind randomized trial.","volume":"105","author":"Whitcomb","year":"2010","journal-title":"Am J Gastroenterol"},{"issue":"2","key":"jrv260002r85","doi-asserted-by":"publisher","first-page":"165","DOI":"10.14309\/ajg.0000000000000501","article-title":"ACG clinical guideline: small intestinal bacterial overgrowth.","volume":"115","author":"Pimentel","year":"2020","journal-title":"Am J Gastroenterol"},{"issue":"1","key":"jrv260002r86","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/apt.13227","article-title":"Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea.","volume":"42","author":"Slattery","year":"2015","journal-title":"Aliment Pharmacol Ther"},{"issue":"1","key":"jrv260002r87","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1186\/s12876-019-1102-1","article-title":"Methods for diagnosing bile acid malabsorption: a systematic review.","volume":"19","author":"Lyutakov","year":"2019","journal-title":"BMC Gastroenterol"},{"issue":"6","key":"jrv260002r88","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1111\/apt.14214","article-title":"Performance characteristics of serum C4 and FGF19 measurements to exclude the diagnosis of bile acid diarrhoea in IBS-diarrhoea and functional diarrhoea.","volume":"46","author":"Vijayvargiya","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"issue":"3","key":"jrv260002r89","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1053\/j.gastro.2019.07.004","article-title":"AGA clinical practice guidelines on the laboratory evaluation of functional diarrhea and diarrhea-predominant irritable bowel syndrome in adults (IBS-D).","volume":"157","author":"Smalley","year":"2019","journal-title":"Gastroenterology"},{"issue":"4","key":"jrv260002r90","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/S2468-1253(22)00401-0","article-title":"Efficacy and safety of colesevelam for the treatment of bile acid diarrhoea: a double-blind, randomised, placebo-controlled, phase 4 clinical trial.","volume":"8","author":"Borup","year":"2023","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"10","key":"jrv260002r91","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1016\/S2468-1253(22)00198-4","article-title":"Safety and efficacy of liraglutide versus colesevelam for the treatment of bile acid diarrhoea: a randomised, double-blind, active-comparator, non-inferiority clinical trial.","volume":"7","author":"K\u00e5rhus","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"jrv260002r34","volume-title":"Irritable Bowel Syndrome in Adults: Diagnosis and Management","year":"2017"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2845755\/jama_singh_2026_rv_260002_1781124439.70582.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:00:43Z","timestamp":1781190043000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2845755"}},"subtitle":["A Review"],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":91,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2026,4,14]]}},"URL":"https:\/\/doi.org\/10.1001\/jama.2026.0872","relation":{},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4,14]]}}}