Investigations | Potential results | Clinical management plan: abnormal results |
---|---|---|
1st Line | ||
Dietary assessment | Inappropriate fluid and fibre intake Excessive sorbitol Excessive caffeine | Dietary advice about healthy fibre and general dietary intake. |
Medication assessment | Drug induced, eg,
| Medications advice. |
Routine blood tests and calcium, ESR, CRP | Abnormal results | Follow treatment of abnormal blood results (pages 2–3). |
Abdominal X-ray | Faecal loading/faecal impaction |
|
2nd Line | ||
OGD and duodenal aspirate ± glucose hydrogen (methane) breath tests | SIBO | Treatment for SIBO (page 17). |
Flexible sigmoidoscopy | Newly diagnosed IBD |
|
Ultrasound of biliary tree and small bowel (if no recent CT scan of abdomen and pelvis) | Suggestive of gallstones, IBD, tumour recurrence, other | Discuss with supervising clinician within 24 h and refer as clinically appropriate to a GI surgeon/gastroenterologist/oncology team. |
If all tests are negative, but symptoms persist |
|
CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; GI, gastrointestinal; IBD, inflammatory bowel disease; OGD, oesophago-gastroduodenoscopy; SIBO, small intestinal bacterial overgrowth.