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Guideline

Laboratory evaluation of functional diarrhea and diarrhea-predominant irritable bowel syndrome in adults (IBS-D)

How to choose the best laboratory tests to identify functional diarrhea and diarrhea-predominant irritable bowel syndrome (IBS-D) in adults and exclude other diagnoses. These guidelines apply to the evaluation of the immunocompetent patient with “watery” diarrhea of at least 4 weeks duration.

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Recommendations

1. In patients presenting with chronic diarrhea, AGA suggests the use of either fecal calprotectin or fecal lactoferrin to screen for inflammatory bowel disease (IBD).

2. In patients presenting with chronic diarrhea, AGA suggests against the use of erythrocyte sedimentation rate or C-reactive protein to screen for IBD.

3. In patients presenting with chronic diarrhea, AGA recommends testing for Giardia.

4. In patients presenting with chronic diarrhea with no travel history to or recent immigration from high-risk areas, AGA suggests against testing for ova and parasites (other than Giardia).

5. In patients presenting with chronic diarrhea, AGA recommends testing for celiac disease with immunoglobulin A (IgA) tissue transglutaminase and a second test to detect celiac disease in the setting of IgA deficiency.

6. In patients presenting with chronic diarrhea, AGA suggests testing for bile acid diarrhea.

7. In patients presenting with chronic diarrhea, AGA makes no recommendation for the use of currently available serologic tests for diagnosis of irritable bowel syndrome (IBS).

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