September 27, 2019
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AGA issues new chronic diarrhea guidelines

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The American Gastroenterological Association released new clinical practice guidelines for the evaluation of chronic diarrhea.

Specifically, the guidelines aim to provide recommendations on which laboratory tests clinicians should use to exclude other diagnoses when they have a patient with suspected functional diarrhea or diarrhea-predominant irritable bowel syndrome.

“When managing patients with chronic watery diarrhea, it is important for health care providers to determine whether it is being caused by organic disease or a functional disorder, such as functional diarrhea or irritable bowel syndrome with diarrhea,” Walter Smalley, MD, MPH, of the Veterans Affairs Tennessee Valley Healthcare System and Vanderbilt University School of Medicine, said in a press release. “Both functional diarrhea and IBS-D are clinical diagnoses with no defining laboratory tests. A workup to exclude all organic disease is impractical, expensive and potentially dangerous to patients if false-positive tests result in further invasive testing. The AGA guideline on evaluation of chronic diarrhea is intended to reduce practice variation and promote high-quality and high-value care for this patient population.”

The new guidelines are directed toward patients who have a working immune system and have watery diarrhea for a duration of at least 4 weeks. Patients with bloody diarrhea, diarrhea with signs of poor fat absorption, features of alarm systems like weight loss, anemia and hypoalbuminemia, family history of inflammatory bowel disease, colon cancer or celiac disease, and patients who have traveled to areas where diarrhea-related diseases are coming are excluded from the guidelines.

The AGA issued seven recommendations for the use of laboratory tests for patients presenting with chronic diarrhea:

  • Test for markers of inflammatory conditions — such as IBD — like fecal calprotectin or fecal lactoferrin.
  • The AGA suggests against using erythrocyte sedimentation rate or C-reactive protein to screen for IBD.
  • Screen for Giardia.
  • In patients with no travel history to high-risk areas, do not screen for ova or parasites, other than Giardia.
  • Test for celiac disease with IgA tissue transglutaminase and a second test to detect celiac disease in the setting of IGA deficiency.
  • Screen for bile acid diarrhea.
  • The AGA made no recommendation on the use of currently available serological tests for the diagnosis of IBS. – by Alex Young

Disclosures: The authors report no relevant financial disclosures.