InvestigationsPotential resultsClinical management plan: abnormal results
1st Line
Stool sample for faecal elastaseEPISee EPI (page 16).
Routine blood screen and additional blood screenAddison's disease Coeliac disease
Thyroid dysfunction
Follow treatment abnormal blood results (pages 2–3).
SeHCAT scanBAMTreatment for BAM (page 16).
Glucose hydrogen (methane) breath test for bacterial overgrowth and/or OGD and D2 asp and biopsiesSIBOTreatment for SIBO (page 17).
Intestinal parasitesTreat with antibiotics within level of confidence or discuss with microbiologists and supervising clinician.
2nd Line
Gut hormones (Chromogranin A&B, gastrin, substance P, VIP, calcitonin, somatostatin, pancreatic polypeptide) and Urinary 5-HIAA and CT/MR liver and abdomenPancreatic neuroendocrine tumourDiscuss and refer urgently to the appropriate neuroendocrine tumour team, requesting an appointment within 2 weeks.
CT abdo pelvis/capsule endoscopy/MRI enteroclysisSmall intestinal disease other than radiotherapy induced (eg, lymphoma)Discuss immediately and refer urgently to the appropriate team requesting an appointment within 2 weeks.
If all tests are negative, but symptoms persist
  1. Trial of empirical antibiotics to exclude test negative SIBO (page 17).

  2. Trial of low fat diet.

  • BAM, bile acid malabsorption; EPI, excocrine pancreatic insufficiency; OGD, oesophago-gastroduodenoscopy; SIBO, small intestinal bacterial overgrowth.