GuidelineThe role of endoscopy in the management of patients with diarrhea
Section snippets
Immunocompetent HOST
Infectious diarrheal illnesses in otherwise healthy individuals are common and short-lived and rarely require specific therapy.5 Therefore, endoscopy is not warranted for the initial evaluation of acute diarrhea.6 However, an endoscopic evaluation should be considered for patients with persistent symptoms, inconclusive diagnosis after routine blood and stool tests, or failure to respond to empirical therapy.7
Immunocompromised Host
Causes of diarrheal illnesses in immunocompromised patients are often different from those in immunocompetent patients. Stool testing for pathogens is the first-line evaluation, whereas endoscopy is generally indicated only when the diarrheal illness is persistent and stool tests fail to reveal a cause.63, 64 In patients with severe diarrhea, it may be possible to omit the bowel preparation.
One of the more common infectious etiologies of diarrhea in patients immunocompromised by organ or stem
Recommendations
- 1.
Stool and laboratory tests should be the initial step for the evaluation of clinical scenarios suggestive of infectious diarrhea. ⊕⊕⊕○
- 2.
In patients with chronic unexplained diarrhea, we suggest colonoscopy with random biopsies of the right and left side of the colon. Sigmoidoscopy is an alternative option, although this may miss right-sided organic disease. ⊕⊕○○
- 3.
We recommend intubation of the terminal ileum during colonoscopy for patients undergoing evaluation of chronic diarrhea. ⊕⊕⊕○ There are
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