TableĀ 7

Investigation and management of borborygmi

InvestigationsPotential resultsClinical management plan
Actions from history, medication and dietary assessment
History findingsFaecal loadingPlain AXR.
MassCT scan.
Fibre excess/inadequacyRefer for dietetic advice.
First line
Routine and additional blood testsAbnormal resultsFollow treatment for abnormal blood results (p. 2).
Glucose hydrogen methane breath testSIBOManagement of SIBO (p. 27).
OGD and SI aspirate (p. 25) and biopsiesEnteric infectionTreat as recommended by microbiologist.
SIBOManagement of SIBO (p. 27).
Coeliac diseaseRefer to coeliac clinic/dietitians/gastroenterology.
Carbohydrate challengeCarbohydrate malabsorptionManagement of carbohydrate malabsorption (p. 26).
Second line, if borborygmi are present in combination with other symptoms: flushing, abdominal pain, diarrhoea, wheezing, tachycardia or fluctuations in BP
Fasting gut hormones
Chromogranin A+B
Urinary 5-HIAA
CT chest, abdomen, pelvis
Functioning NET eg, carcinoid syndrome or pancreatic NETDiscuss and refer urgently to the appropriate neuroendocrine MDT requesting an appointment within 2 weeks.
Plain AXRIleus/obstructionThis is an emergency. Discuss immediately with a GI surgeon and arrange urgent CT scan.
Faecal loadingSee management of constipation (p. 26).
Third line
ColonoscopyInflammatory bowel diseaseSend stool culture.
If mild or moderate, refer urgently to gastroenterology.
If severe, this is an emergency. Discuss immediately with a gastroenterologist.
Fourth line
If normal investigations/no response to interventionReassure.
  • 5HIAA, 5-hydroxyindole acetic acid; AXR, abdominal X-ray; CT, computerised tomography; GI, gastrointestinal; MDT, multidisciplinary team; NET, neuroendocrine tumour; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); SIBO, small intestinal bacterial overgrowth.