InvestigationsPotential resultsClinical management plan: abnormal results
1st Line
Dietary assessmentInappropriate fluid and fibre intake
Excessive sorbitol
Excessive caffeine		Dietary advice about healthy fibre and general dietary intake.
Medication assessmentDrug induced, eg,

  • opioid

  • ondansetron

  • anti-muscarinics

  • loperamide

  • iron supplement

  • statin

  • metformin

Medications advice.
Routine blood tests and calcium, ESR, CRPAbnormal resultsFollow treatment of abnormal blood results (pages 2–3).
Abdominal X-rayFaecal loading/faecal impaction

  1. Full bowel clearance, eg, Picolax, Klean-Prep.

  2. Maintenance bulk laxative.

  3. Correct positioning on lavatory (toileting exercises) (page 18).

2nd Line
OGD and duodenal aspirate ± glucose hydrogen (methane) breath testsSIBOTreatment for SIBO (page 17).
Flexible sigmoidoscopyNewly diagnosed IBD

  1. Send stool culture.

  2. If mild or moderate, refer within 2 weeks to a gastroenterologist.

    If severe, this is an emergency—discuss immediately with a gastroenterologist.

Ultrasound of biliary tree and small bowel (if no recent CT scan of abdomen and pelvis)Suggestive of gallstones, IBD, tumour recurrence, otherDiscuss 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

  1. Consider CT abdomen and pelvis.

  2. Consider lower GI endoscopic assessment.

  3. Refer to a specialist pain team for further assessment.

  4. Consider antispasmodics. Consider low-dose antidepressants.

  5. Consider agent for neuropathic pain.

  6. Consider referral for acupuncture.

  • CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; GI, gastrointestinal; IBD, inflammatory bowel disease; OGD, oesophago-gastroduodenoscopy; SIBO, small intestinal bacterial overgrowth.