Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition

doi:10.1136/gutjnl-2017-315909

Practice Guideline

. 2018 Aug;67(8):1380-1399.

doi: 10.1136/gutjnl-2017-315909. Epub 2018 Apr 13.

Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition

Ramesh P Arasaradnam^{1

2

3}, Steven Brown⁴, Alastair Forbes⁵, Mark R Fox^{6

7}, Pali Hungin⁸, Lawrence Kelman⁹, Giles Major¹⁰, Michelle O'Connor⁹, Dave S Sanders⁴, Rakesh Sinha¹¹, Stephen Charles Smith¹², Paul Thomas¹³, Julian R F Walters¹⁴

Affiliations

¹ University Hospital Coventry, Coventry, UK.
² Department of Applied Biological Sciences, University of Coventry, Coventry, UK.
³ Clinical Sciences Research Institute, University of Warwick, Warwick, UK.
⁴ Sheffield Teaching Hospitals, Sheffield, UK.
⁵ Norwich Medical School, University of East Anglia, Norwich, UK.
⁶ University of Zürich, Zürich, Switzerland.
⁷ Abdominal Centre, St Claraspital, Basel, Switzerland.
⁸ School of Medicine, Pharmacy & Health, University of Durham, Durham, UK.
⁹ Patient Representative, Secretary BAM Support, Coventry, UK.
¹⁰ NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
¹¹ Department of Radiology, South Warwickshire Hospitals, Warwick, UK.
¹² Department of Clinical Biochemistry, Midlands and NW Bowel Cancer Screening Hub, Rugby, UK.
¹³ Department of Gastroenterology, Musgrave Park Hospital, Taunton, UK.
¹⁴ Division of Digestive Diseases, Imperial College London, London, UK.

PMID: 29653941
PMCID: PMC6204957
DOI: 10.1136/gutjnl-2017-315909

Practice Guideline

Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition

Ramesh P Arasaradnam et al. Gut. 2018 Aug.

. 2018 Aug;67(8):1380-1399.

doi: 10.1136/gutjnl-2017-315909. Epub 2018 Apr 13.

Authors

Affiliations

¹ University Hospital Coventry, Coventry, UK.
² Department of Applied Biological Sciences, University of Coventry, Coventry, UK.
³ Clinical Sciences Research Institute, University of Warwick, Warwick, UK.
⁴ Sheffield Teaching Hospitals, Sheffield, UK.
⁵ Norwich Medical School, University of East Anglia, Norwich, UK.
⁶ University of Zürich, Zürich, Switzerland.
⁷ Abdominal Centre, St Claraspital, Basel, Switzerland.
⁸ School of Medicine, Pharmacy & Health, University of Durham, Durham, UK.
⁹ Patient Representative, Secretary BAM Support, Coventry, UK.
¹⁰ NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
¹¹ Department of Radiology, South Warwickshire Hospitals, Warwick, UK.
¹² Department of Clinical Biochemistry, Midlands and NW Bowel Cancer Screening Hub, Rugby, UK.
¹³ Department of Gastroenterology, Musgrave Park Hospital, Taunton, UK.
¹⁴ Division of Digestive Diseases, Imperial College London, London, UK.

PMID: 29653941
PMCID: PMC6204957
DOI: 10.1136/gutjnl-2017-315909

Abstract

Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations.

Keywords: diarrhoea; diarrhoeal disease.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Algorithm for the investigation of chronic diarrhoea based on clinical differential diagnosis.

See this image and copyright information in PMC

Comment in

Chronic diarrhoea: the indications for lower GI endoscopy when functional bowel disease is suspected.
Ong J, Swift C, Allwood I, Norman R, Al-Naeeb Y, Shankar A. Ong J, et al. Gut. 2019 Nov;68(11):2100. doi: 10.1136/gutjnl-2018-317574. Epub 2018 Oct 30. Gut. 2019. PMID: 30377192 No abstract available.
Role of endoscopy in chronic diarrhoea when functional bowel disease is suspected.
Arasaradnam RP, Walters JRF. Arasaradnam RP, et al. Gut. 2020 Jan;69(1):190-191. doi: 10.1136/gutjnl-2018-317730. Epub 2018 Dec 3. Gut. 2020. PMID: 30510109 Free PMC article. No abstract available.
The investigation of chronic diarrhoea: new BSG guidance.
Ong J, Swift C, Norman R, Allwood I, Al-Naeeb Y, Shankar A. Ong J, et al. Br J Gen Pract. 2019 May;69(682):262-264. doi: 10.3399/bjgp19X702653. Br J Gen Pract. 2019. PMID: 31023694 Free PMC article. No abstract available.

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References

1. Brouwers MC, Kho ME, Browman GP, et al. . AGREE II: advancing guideline development, reporting and evaluation in health care. Can Med Assoc J 2010;182:E839–E842. 10.1503/cmaj.090449 - DOI - PMC - PubMed
1. Guyatt G, Oxman AD, Akl EA, et al. . GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011;64:383–94. 10.1016/j.jclinepi.2010.04.026 - DOI - PubMed
1. Oxford University. Centre for evidence-based medicine. Oxford: Oxford University, 2009.
1. Lacy BE, Mearin F, Chang L, et al. . Bowel disorders. Gastroenterology 2016;150:1393–407. 10.1053/j.gastro.2016.02.031 - DOI - PubMed
1. Wenzl HH, Fine KD, Schiller LR, et al. . Determinants of decreased fecal consistency in patients with diarrhea. Gastroenterology 1995;108:1729–38. 10.1016/0016-5085(95)90134-5 - DOI - PubMed

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[1] Brouwers MC, Kho ME, Browman GP, et al. . AGREE II: advancing guideline development, reporting and evaluation in health care. Can Med Assoc J 2010;182:E839–E842. 10.1503/cmaj.090449 - DOI - PMC - PubMed

[2] Brouwers MC, Kho ME, Browman GP, et al. . AGREE II: advancing guideline development, reporting and evaluation in health care. Can Med Assoc J 2010;182:E839–E842. 10.1503/cmaj.090449 - DOI - PMC - PubMed

[3] Guyatt G, Oxman AD, Akl EA, et al. . GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011;64:383–94. 10.1016/j.jclinepi.2010.04.026 - DOI - PubMed

[4] Guyatt G, Oxman AD, Akl EA, et al. . GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011;64:383–94. 10.1016/j.jclinepi.2010.04.026 - DOI - PubMed

[5] Oxford University. Centre for evidence-based medicine. Oxford: Oxford University, 2009.

[6] Oxford University. Centre for evidence-based medicine. Oxford: Oxford University, 2009.

[7] Lacy BE, Mearin F, Chang L, et al. . Bowel disorders. Gastroenterology 2016;150:1393–407. 10.1053/j.gastro.2016.02.031 - DOI - PubMed

[8] Lacy BE, Mearin F, Chang L, et al. . Bowel disorders. Gastroenterology 2016;150:1393–407. 10.1053/j.gastro.2016.02.031 - DOI - PubMed

[9] Wenzl HH, Fine KD, Schiller LR, et al. . Determinants of decreased fecal consistency in patients with diarrhea. Gastroenterology 1995;108:1729–38. 10.1016/0016-5085(95)90134-5 - DOI - PubMed

[10] Wenzl HH, Fine KD, Schiller LR, et al. . Determinants of decreased fecal consistency in patients with diarrhea. Gastroenterology 1995;108:1729–38. 10.1016/0016-5085(95)90134-5 - DOI - PubMed

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Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition

Affiliations

Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition

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Abstract

Conflict of interest statement

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