Investigation and management of steatorrhoea
| Investigations | Potential results | Clinical management plan |
|---|---|---|
| First line | ||
| Stool sample for faecal elastase | Pancreatic insufficiency | Management of EPI (p. 26). |
| Routine and additional blood tests | Addison's disease Coeliac disease Thyroid dysfunction | Follow treatment for abnormal blood results (p. 2). |
| Blood tests for malabsorptive symptoms | Malabsorptive pathology | Follow treatment for abnormal blood results (p. 2). |
| SeHCAT scan | BAM | Management of BAM (p. 25). |
| OGD and SI aspirate and biopsies (p. 25) | SIBO | Management of SIBO (p. 27). |
| Intestinal parasites | Treat with antibiotics within level of confidence or discuss with microbiologists and supervising clinician. | |
| Glucose hydrogen methane breath test | SIBO | Management of SIBO (p. 27). |
| Second line | ||
| Gut hormones (Chromogranin A and B, gastrin, substance P, VIP, calcitonin, somatostatin, pancreatic polypeptide) and urinary 5-HIAA and CT/MRI liver and abdomen | Neuroendocrine tumour | Discuss and refer urgently to the appropriate neuroendocrine MDT requesting an appointment within 2 weeks. |
| CT abdomen pelvis/capsule endoscopy/MRI enteroclysis | Small intestinal disease | Discuss immediately and refer to the appropriate MDT requesting an appointment within 2 weeks, or if no malignancy to a gastroenterologist. |
| Third line | ||
| If normal investigations/no response to intervention |
| |
5HIAA, 5-hydroxyindole acetic acid; BAM, bile acid malabsorption; CT, computerised tomography; EPI, exocrine pancreatic insufficiency; MDT, multidisciplinary team; MRI, magnetic resonance imaging; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); SeHCAT, 23-seleno-25-homotaurocholic acid; SIBO, small intestinal bacterial overgrowth; VIP, vasoactive intestinal protein.