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Curr Opin Gastroenterol

Title:		Chronic diarrhoea in adults: what not to miss
Author(s):		Major GAD; Gunn D;
Address:		"NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust. Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK"
Journal Title:		Curr Opin Gastroenterol
Year:		2019
Volume:		35
Issue:		3
Page Number:		206 - 212
DOI:		10.1097/MOG.0000000000000516
ISSN/ISBN:		1531-7056 (Electronic) 0267-1379 (Linking)
Abstract:		"PURPOSE OF REVIEW: Chronic diarrhoea remains a diagnostic challenge, with numerous causes and few effective symptomatic treatments. This review focuses on new methods for diagnosis of common disorders and alerts readers to rarer causes through a systematic approach to the underlying mechanisms. RECENT FINDINGS: New strategies are emerging to stratify the need for endoscopic investigation. Faecal immunochemical testing, combined with standard blood tests, shows promise in excluding colorectal cancers, adenoma and inflammatory bowel disease, challenging the current use of faecal calprotectin. Serum analysis for markers of bile acid synthesis has been refined, potentially streamlining diagnostic pathways of bile acid malabsorption for those who are unable to access nuclear medicine scans, but the positive predictive value of faecal elastase in low prevalence populations has been questioned. Novel markers such as volatile organic compounds and stool DNA analyses continue to develop. SUMMARY: A systematic approach to investigation of chronic diarrhoea will ensure all relevant causes are considered and minimize the chance of a missed diagnosis. Combination of clinical features with noninvasive testing supports a judicious approach to endoscopic investigations but further innovation will be needed to resolve the diagnostic challenge that diarrhoea poses"
Keywords:		Adenocarcinoma/complications/*diagnosis Adenoma/complications/*diagnosis Antidiarrheals/therapeutic use Bile Acids and Salts/metabolism Celiac Disease/complications/diagnosis Chronic Disease Colorectal Neoplasms/complications/*diagnosis Diarrhea/complicat;
Notes:		"MedlineMajor, Giles A D Gunn, David eng BRC-1215-20003/DH_/Department of Health/United Kingdom MRC_/Medical Research Council/United Kingdom Research Support, Non-U.S. Gov't Review 2019/03/19 Curr Opin Gastroenterol. 2019 May; 35(3):206-212. doi: 10.1097/MOG.0000000000000516"