InvestigationsPotential resultsClinical management plan: abnormal results
1st Line
Routine AND additional blood screen (pages 2–3)Abnormal resultsFollow treatment of abnormal blood results (pages 2–3).
OGD and duodenal aspirate and biopsies and/or glucose hydrogen methane breath testsSIBOTreatment for SIBO (page 17).
Enteric infectionTreat as recommended by microbiologist.
Carbohydrate challengeCarbohydrate malabsorptionTreatment for carbohydrate malabsorption (pages 16–17).
If borgorygmi are present in combination with other symptoms: flushing, abdominal pain, diarrhoea, wheezing, tachycardia or fluctuation in BP
2nd Line
Fasting gut hormones
+ Urinary 5-HIAA + CT scan chest, abdomen and pelvis
Functioning NET, eg, carcinoid syndrome or pancreatic NETDiscuss and refer urgently to the appropriate neuroendocrine tumour team requesting an appointment within 2 weeks.
If all tests are negative, but symptoms persistReassure.
  • OGD, oesophago-gastroduodenoscopy; NET, neuroendocrine tumour; SIBO, small intestinal bacterial overgrowth.