| Investigations | Potential results | Clinical management plan: abnormal results |
|---|---|---|
| 1st Line | ||
| Stool sample for faecal elastase | EPI | See EPI (page 16). |
| Routine blood screen and additional blood screen | Addison's disease Coeliac disease Thyroid dysfunction | Follow treatment abnormal blood results (pages 2–3). |
| SeHCAT scan | BAM | Treatment for BAM (page 16). |
| Glucose hydrogen (methane) breath test for bacterial overgrowth and/or OGD and D2 asp and biopsies | SIBO | Treatment for SIBO (page 17). |
| Intestinal parasites | Treat 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 abdomen | Pancreatic neuroendocrine tumour | Discuss and refer urgently to the appropriate neuroendocrine tumour team, requesting an appointment within 2 weeks. |
| CT abdo pelvis/capsule endoscopy/MRI enteroclysis | Small 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 |
| |
BAM, bile acid malabsorption; EPI, excocrine pancreatic insufficiency; OGD, oesophago-gastroduodenoscopy; SIBO, small intestinal bacterial overgrowth.