Gut 52:v1-v15 doi:10.1136/gut.52.suppl_5.v1

Guidelines for the investigation of chronic diarrhoea, 2nd edition

  1. P D Thomas1,
  2. A Forbes2,
  3. J Green3,
  4. P Howdle4,
  5. R Long5,
  6. R Playford6,
  7. M Sheridan7,
  8. R Stevens8,
  9. R Valori9,
  10. J Walters6,
  11. G M Addison10,
  12. P Hill11,
  13. G Brydon12
  1. 1Department of Gastroenterology, Musgrave Park Hospital, Taunton, UK
  2. 2Department of Gastroenterology, St Mark’s Hospital, Harrow, UK
  3. 3Department of Gastroenterology, Llandough Hospital, Penarth, UK
  4. 4Department of Gastroenterology, St James’s University Hospital, Leeds, UK
  5. 5Department of Gastroenterology, City Hospital, Nottingham, UK
  6. 6Department of Gastroenterology, Hammersmith Hospital, London, UK
  7. 7Department of Radiology, St James’s Hospital, Leeds, UK
  8. 8GP, East Oxford Health Centre, Oxford, UK
  9. 9Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
  10. 10Department of Clinical Chemistry, Royal Manchester Children’s Hospital, Manchester, UK
  11. 11Department of Clinical Chemistry, Hope Hospital, Manchester, UK
  12. 12Clinical Scientist, Western General Hospital, Edinburgh, UK
  1. Correspondence to:
    Dr A Forbes, St Mark’s Hospital, Harrow, Middlesex HA1 3UJ, UK;

    1.0 PREFACE

    1.1 Purpose of guidelines

    These guidelines were compiled at the request of the Chairman of the British Society of Gastroenterology’s clinical services committee. The guidelines are directed at consultant gastroenterologists, specialist registrars in training, and general practitioners, and refer specifically to adult not paediatric gastroenterology. Their purpose is to provide guidance on the best available methods of investigating symptoms of chronic diarrhoea. Given this broad symptom based focus, the guidelines cover a wide range of gastroenterological conditions and are not intended as a comprehensive review of all aspects of the clinical conditions mentioned herein, but rather an attempt to rationalise the approach to investigation in the context of this common clinical scenario.

    1.2 Development of guidelines

    The guidelines were prepared following a comprehensive literature search by Dr PD Thomas. This involved a review of electronic databases (Medline and PubMed) using keywords such as “diarrhea”, “chronic”, “diagnostic evaluation”, “investigation”, “malabsorption”, and terms related to the specific conditions mentioned in the text (for example, coeliac disease and small bowel bacterial overgrowth). Papers relating to diarrhoea in the context of immunodeficiency syndromes were specifically excluded from this review as this subject was felt to require a different investigative approach. A total of 530 key papers and relevant abstracts in English in peer reviewed journals were identified and read, and relevant work has been cited and referenced. An initial draft document was produced and subsequently reviewed and modified by a multidisciplinary group comprising clinical gastroenterologists, radiologists, and biochemists.

    1.3 Grading of recommendations

    The strength of each recommendation is dependant on the category of evidence supporting it and is graded as follows:

  • Requires evidence from at least one randomised controlled trial or a meta-analysis of randomised controlled trials.

  • Requires evidence from prospective, retrospective, or cross sectional clinical studies without randomisation.

  • Evidence based on expert reports or opinion in the absence of directly applicable studies of good quality. …

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