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Question clinique
What work-up should be considered for patients with chronic diarrhea?
L’Essentiel
Though not offering an algorithm to guide the work-up, the American Gastroenterological Association suggests the following tests for patients with chronic diarrhea (ie, watery diarrhea for at least 4 weeks): fecal calprotectin or fecal lactoferrin to screen for inflammatory bowel disease (IBD), and testing for giardiasis, celiac disease, and bile acid diarrhea. They recommend not screening for ova and parasites unless the patient has come from a high-risk area. They also recommend against using erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to screen for IBD. 5
Référence
Plan de l'etude: Practice guideline
Financement: Foundation
Cadre: Various (guideline)
Sommaire
This guideline was developed by a team comprising 2 gastroenterologists, a primary care physician, and a methodologist, but no patient representative. They performed a systematic review and graded the level of evidence using the GRADE rubric. One team member reported financial relationships with companies that make diagnostic or treatment products for gastrointestinal disorders. In patients with chronic diarrhea, the group suggests screening for IBD using fecal calprotectin or fecal lactoferrin, but not ESR or CRP (conditional recommendation based on low-quality evidence). They also recommend testing for giardia (strong recommendation, high-quality evidence), but recommend against testing for ova or other parasites unless the patient is from or has traveled to a high-risk area (conditional recommendation, low-quality evidence). They also suggest testing for celiac disease (strong recommendation, moderate-quality evidence) and testing for bile acid diarrhea by assay or by an empiric trial of a bile acid binder (conditional recommendation, low-quality evidence). Unfortunately, the group does not recommend a specific order of testing.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Commentaires
Subject : Chronic Diarrhea of patients/clients.
Dear Respected Team-CMA-Canada,
As International Resident Member(IMG)-CMAID-680777-CMA-Canada ,I have read about Chronic Diarrhea of patients mentioned above .
Due to Chronic Diarrhea , patients much keep Heath awareness , clean dress , clean bed , clean house /home , clean human body with daily bath .
He/she must take good foods ,pure vegetables,pure water etc in daily life styles. The patients/clients must visit doctors /family doctors /Heath care practitioners /nuse doctors for prescribed medicine and counseling.
The patients can take home rest by the prescribed medicine and counseling of physicians. In the case of children ,parents must take them to doctors for prescribed medicine and counseling for soon recovery. Best wishes. Respectfully.
Good Heath to you all.
Dr.Muhammad Arif Rana
Global Family Doctor (LDM Roll-224)-WONCA at SIG Based in Manikganj-Bangladesh.
International Resident Member (IMG)-CMAID-680777-CMA-Canada.
Email:muhammadarifrana3@gmail.com Date: October 04-2019-Friday-07:06 PM.
Respectfully.
NOTE: Discussion/Comment NO# 04 , Date : October 04-2019.