Clinical features and follow-up of surreptitious laxative users1

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Surreptitious laxative use may mimic several organic diarrhea syndromes, including inflammatory bowel disease and secretory diarrhea. Seventeen cases of surreptitious laxative use were uncovered within five years at the Cleveland Clinic. Characteristic features included diarrhea, abdominal pain, nausea and vomiting, and weight loss. Findings on physical examination were nonspecific, and laboratory and roentgenographic studies were not helpful. Two patients were also covertly taking diuretics. The diagnosis was made by stool analysis for phenolphthalein and by room search. Psychiatric treatment, although not always accepted or helpful, was recommended in each case. Follow-up indicated that about half the patients had improved once the diagnosis was established.



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