Guideline for chronic diarrhea: screening for IBD and celiac disease is in, screening for ova and parasites is out

Reference

Smalley W, Falck-Ytter C, Carrasco-Labra A, Wani S, Lytvyn L, Falck-Ytter Y. AGA clinical practice guidelines on the laboratory evaluation of functional diarrhea and diarrhea-predominant irritable bowel syndrome in adults (IBS-D). Gastroenterology 2019;157(3):851-854.

Synopsis

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.