This tool has been prepared as a resource to assist qualified health care professionals in the decision-making processes relating to the dietary management of bowel dysfunction specifically dietitians and community healthcare professionals.
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Investigating changes in bowel habits may involve a variety of tests, including blood tests, stool tests, colonoscopy, and other imaging. The potential causes are diverse and multiple tests are often needed for an accurate diagnosis.
In patients with gastrointestinal symptoms, checking faecal calprotectin, completing a coeliac screen and undertaking a FIT stool sample can help to differentiate between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), and identify coeliac disease or possible cancer. The results of these tests can inform diagnosis, warrant further investigations that guide treatment pathways but also potentially avoid unnecessary investigations and treatments.
For more information on each of these, please click the links below:
This tool has been developed by gastroenterology specialist dietitians Dr Anne Holdoway and Sophie Medlin to provide healthcare professionals with an analysis and outcome pathway when assessing a patients stool.
When healthcare professionals request serological tests to investigate suspected coeliac disease in young people and adults, laboratories should: test for total immunoglobulin A (IgA) and IgA tissue transglutaminase (tTG) as the first choice, use IgA endomysial antibodies (EMA) if IgA tTG is weakly positive, consider using IgG EMA, IgG deamidated gliadin peptide (DGP) or IgG tTG if IgA deficient (IgA deficiency (add in hyperlink to NICE coeliac guidance). The test is accurate only if a gluten‑containing diet is eaten during the diagnostic process. A person should not start a gluten‑free diet until diagnosis is confirmed by a specialist, even if the results of a serological test are positive. Although IgA tTG will fall in response to a gluten-free diet in an individual with coeliac disease, the time period can vary and so it should not be relied upon alone as a measure of strict adherence to a gluten-free diet but be used in conjunction with a detailed diet history carried out by a dietitian skilled in the dietary management of coeliac disease.