Medical Articles

Not your average diarrhoea

Patient LF

  • 40 year old male
  • Progressive watery diarrhoea, 8-10 episodes per day for 6 months
  • No associated symptoms
  • No mucus or blood in stool
  • No weight loss

Further history

  • No history of travel
  • Strong alcohol history (Stopped 3 years ago)
  • No past medical or surgical history
  • No previous chronic diarrhoea
  • No other family members affected


  • FBC, LFT, Alb, TFT, CRP normal
  • HIV negative
  • Faecal elastase normal
  • Stool MCS normal
  • Colonoscopy normal – random biopsies taken


  • Histology revealed spirochetosis


  • Flagyl 400mg three times daily for 14 days
  • Excellent response with normalisation of stool frequency within 7 days

Spirochetosis: An overview

  • Borrelia eurygyrata, Brachyspira aalborgi, or Serpulina pilosicoli.
  • Genetically unrelated to nonintestinal spirochetes, such as Treponema pallidum.
  • Patients may be asymptomatic or present with watery diarrhoea, weight loss, abdominal pain and rectal bleeding.
  • Treatment is with Flagyl 400mg tds x14 days