Investigations | Potential results | Clinical management plan |
---|---|---|
Actions from history, medication and dietary assessment | ||
History findings | Faecal loading | Plain AXR. |
Obstruction | ||
Mass | CT scan. | |
Fibre excess/inadequacy | Refer for dietetic advice. | |
First line | ||
Routine and additional blood tests | Abnormal results | Follow treatment for abnormal blood results (p. 2). |
Glucose hydrogen methane breath test | SIBO | Management of SIBO (p. 27). |
OGD and SI aspirate (p. 25) and biopsies | Enteric infection | Treat as recommended by microbiologist. |
SIBO | Management of SIBO (p. 27). | |
Coeliac disease | Refer to coeliac clinic/dietitians/gastroenterology. | |
Carbohydrate challenge | Carbohydrate malabsorption | Management 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 NET | Discuss and refer urgently to the appropriate neuroendocrine MDT requesting an appointment within 2 weeks. |
Plain AXR | Ileus/obstruction | This is an emergency. Discuss immediately with a GI surgeon and arrange urgent CT scan. |
Faecal loading | See management of constipation (p. 26). | |
Third line | ||
Colonoscopy | Inflammatory bowel disease | Send 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 intervention | Reassure. |
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.