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

3rd edition | Part 1

Clinical assessment ► We recommend a careful detailed history to plan investigations (Grade of

evidence level 1, Strength of recommendation strong). ► We recommend screening blood tests for
the exclusion of anaemia, coeliac disease, etc as well as stool tests for inflammation (Grade of
evidence level 1, Strength of recommendation strong). ► We recommend making a positive
diagnosis of irritable bowel syndrome (IBS) following basic blood and stool screening tests (Grade of
evidence level 2, Strength of recommendation strong).

Cancer or inflammation ► We recommend excluding colorectal cancer in those with altered bowel
habit±rectal bleeding by colonoscopy (Grade of evidence level 1, Strength of recommendation
strong). ► We suggest use of testing for faecal blood loss by faecal immunochemical testing in
primary or secondary care, either as an exclusion test or to guide priority of investigations in those
with lower gastrointestinal symptoms (chronic diarrhoea) but without rectal bleeding (Grade of
evidence level 2, Strength of recommendation weak). ► Faecal calprotectin is recommended to
exclude colonic inflammation in those suspected with IBS and under the age of 40 (Grade of
evidence level 1, Strength of recommendation strong).

Secondary clinical assessment ► If symptoms persist despite normal first-line investigations and
treatment, then referral for further investigations is recommended (Grade of evidence level 5,
Strength of recommendation strong). ► We recommend blood and stool tests to exclude
malabsorption and common infections (especially in the immunocompromised or elderly) (Grade of
evidence level 2, Strength of recommendation strong).