Diagnostic Approach to Daily Vomiting and Diarrhea

Age-Specific Considerations

The American College of Radiology suggests that viral gastroenteritis is the most common cause of daily vomiting and diarrhea in infants, presenting with sudden onset vomiting, mild fever, diarrhea, and relatively short duration 1, 3
The American College of Radiology recommends that bilious emesis or forceful vomiting in infants requires urgent evaluation for gastrointestinal obstruction including malrotation with volvulus, hypertrophic pyloric stenosis, or intussusception 1, 3
In adults, the Gut journal suggests that Clostridium difficile infection should be suspected with recent antibiotic use 2, 4

The Gut journal recommends a systematic diagnostic approach, including a critical history elements, such as duration and pattern of symptoms, medication review, and dietary factors, to identify potential causes of daily vomiting and diarrhea 2, 4
The Gut journal suggests that medication review is crucial, as up to 4% of chronic diarrhea cases are medication-induced, particularly from magnesium supplements, ACE inhibitors, NSAIDs, gliptins, antibiotics, and antiarrhythmics 2, 4
The Gut journal recommends considering dietary factors, such as excessive caffeine, lactose in lactase-deficient patients, sugar-free sweeteners, and FODMAPs, as potential causes of symptoms 2, 4, 5

The Gut journal suggests that celiac disease has a prevalence of 0.5-1% in Western populations and commonly presents with chronic diarrhea, and serological testing should be routine 2, 4
The Gut journal recommends considering bile acid malabsorption, particularly in diabetics, as a potential cause of chronic diarrhea 2, 4, 5

The Gut journal suggests that hyperthyroidism causes diarrhea through endocrine effects on gut motility 6, 2, 4
The Gut journal recommends considering diabetes mellitus as a potential cause of diarrhea, via autonomic neuropathy, bacterial overgrowth, bile acid malabsorption, and medication effects 2, 4, 5

The Gut journal recommends basic screening tests, including complete blood count, ESR, CRP, comprehensive metabolic panel, thyroid function tests, and vitamin B12, folate, calcium, and ferritin levels, to identify organic disease with high specificity 2, 4
The Gut journal suggests that serological testing for celiac disease, such as tissue transglutaminase antibodies or antiendomysium antibodies, should be performed 2, 4