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Investigation of chronic diarrhoea
  1. R C G Pollok1
  1. 1Department of Gastroenterology, St George’s Hospital, London SW17 0QT, UK; rpolloksghms.ac.uk
  1. P Thomas2,
  2. A Forbes2
  1. 2St Mark’s Hospital, Watford Road, Harrow HA1 3UJ, UK

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I congratulate the authors of the recently revised “BSG guidelines for the investigation of diarrhoea” for their excellent overview of this important clinical problem.(Gut 2003;52(suppl V):v1–15). I would however take issue with the suggestion that measurement of stool volumes in outpatients is impractical. In my experience such measurement is readily achievable and cheap, merely requiring a suitable container and some weighing scales. A three day stool collection should be considered early in the investigation of chronic diarrhoea, particularly if a factitious aetiology is suspected which is unfortunately often underdiagnosed and over investigated.1

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Authors’ reply

We welcome Dr Pollock’s comments on the use of a three day stool collection in the investigation of chronic diarrhoea. Our concern about its use in the outpatient setting, and particularly when factitious diarrhoea is suspected, is that collection is unsupervised and potentially susceptible to interference. It was for this reason that inpatient collection was suggested. Furthermore, we think there will be widespread doubt by clinicians about the acceptability of this approach. Excepting these caveats, we agree that it is a relatively simple and effective way to assess stool volume which may limit the need for other investigations in these patients.

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