InvestigationsPotential resultsClinical management plan: abnormal results
1st Line
Routine AND
additional blood screen (pages 2–3)		Abnormal resultsFollow treatment of abnormal blood results (pages 2–3).
Abdominal X-raySevere faecal loading

  1. Full bowel clearance, ie, Picolax (Ferring Pharmaceuticals Ltd, West Drayton, UK), Klean-Prep (Norgine Limited, Harefield, UK), Moviprep (Norgine Limited, Harefield, UK).

  2. Maintenance bulk laxative.

  3. Correct positioning on lavatory and pelvic floor exercises (page 18).

Dietary historyInadequate fluid Inadequate/excessive fibre intake
Excessive sorbitol
Excessive caffeine

  1. Dietary advice.

  2. Referral to dietitian and ask patient to complete 7 day dietary diary.

Drug history/medications assessmentConsider stopping opiate drugs/metformin/statins/non-steroidal anti-inflammatory drugs.
2nd Line
OGD and duodenal aspirate and/or glucose hydrogen methane breath testSIBOTreatment for SIBO (page 17).
Stool for faecal elastaseEPITreatment for EPI (page 16).
Dietary history
± challenge test for carbohydrate malabsorption		Carbohydrate intoleranceTreatment for carbohydrate malabsorption (pages 16–17).
Ultrasound of biliary tree and abdomen and pelvis (and small bowel if no CT scan of abdomen and pelvis in the time symptoms have been present/last 3 months)Suggestive of gallstones, inflammatory bowel disease, tumour recurrence, otherDiscuss with supervising clinician and refer as clinically appropriate to a GI surgeon/gastroenterologist/oncology team.
MRI small bowelSmall bowel stenosisDiscuss with supervising clinician and refer as clinically appropriate to a GI surgeon/gastroenterologist/oncology team.
If all tests are negative, but symptoms persist

  1. Reassure.

  2. Antispasmodics.

  3. Low-dose antidepressants.

  4. Consider referral for low FODMAPs diet.

  5. Agent for neuropathic pain if pain severe.

  6. Refer to pain clinic if pain severe.

  7. Consider a referral for acupuncture.

  8. Consider a referral for hypnotherapy.

  • EPI, exocrine pancreatic insufficiency; FODMAPs, fermentable oligo-, di- and mono-saccharides and polyols; GI, gastrointestinal; OGD, oesophago-gastroduodenoscopy; SIBO, small intestinal bacterial overgrowth.