Investigations | Potential results | Clinical management plan |
---|---|---|
Actions from history, medication and dietary assessment | ||
History findings | Smoking | Lifestyle advice about smoking cessation. |
Anxiety | Consider referral for psychological support. | |
Dumping syndrome | See p. 20. | |
Medication findings | Drug induced: eg,
| Medications advice. |
Dietary findings | Low/high fibre intake, high fizzy drink intake, high use of sorbitol containing chewing gum or sweets, high caffeine intake, high alcohol intake |
|
First line | ||
Routine and additional blood tests | Abnormal results | Follow treatment for abnormal blood results (p. 2). |
Mg2+ low | Follow treatment for abnormal blood results (p. 2). | |
Coeliac disease | Refer to coeliac clinic/dietitians/gastroenterology. | |
Stool sample for microscopy, culture and Clostridium difficile toxin | Stool contains pathogens | Treat as recommended by the microbiologist and local protocols. |
Stool sample for faecal elastase | EPI | Management of EPI (p. 26). |
OGD and SI aspirate (p. 25) and SI biopsies | SIBO | Management of SIBO (p. 27). |
Coeliac disease | Refer to coeliac clinic/dietitians/gastroenterology. | |
Giardiasis | Metronidazole. | |
Other GI pathology | Discuss with supervising clinician within 24 hours. | |
Glucose hydrogen methane breath test | SIBO | Management of SIBO (p. 27). |
Carbohydrate challenge | Carbohydrate intolerance/malabsorption | Management of carbohydrate malabsorption (p. 26). |
SeHCAT scan | BAM | Management of BAM (p. 25). |
Colonoscopy with biopsies (if frail, consider flexible sigmoidoscopy instead of colonoscopy) | Macroscopic colitis | Send stool culture. If mild or moderate, refer urgently to gastroenterology. If severe, this is an emergency. Discuss immediately with a gastroenterologist. |
Microscopic colitis | Refer to gastroenterology. | |
Malignancy | Refer urgently to the appropriate MDT requesting an appointment within 2 weeks. | |
Second line | ||
Gut hormones | Functioning NET | Refer to the appropriate NET team requesting an appointment within 2 weeks. |
Third line | ||
If normal investigations/no response to intervention | Refer to gastroenterology. |
BAM, bile acid malabsorption; EPI, exocrine pancreatic insufficiency; GI, gastrointestinal; MDT, multidisciplinary team; Mg2+, magnesium; NET, neuroendocrine tumour; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PPI, proton pump inhibitor; SeHCAT, 23-seleno-25-homotaurocholic acid; SI, small intestine; SIBO, small intestinal bacterial overgrowth.