DÄ internationalArchive25/2012Thinking Outside the Box
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For many years, I have taken an interest in stool diagnostics and diagnosis of chronic gastrointestinal symptoms—the so called irritable bowel syndrome. It is amazing in how many patients in whom traditional medicine has not found any pathological indicators, stool diagnostics shows up the cause for their symptoms. In this scenario, nothing pathological means laboratory testing according to the recommended diagnostic strategy will find only normal serum values, and an absence of pathological bowel bacteria and normal calprotectin in stools. However, the range of diagnostic tools one could deploy is vast. Especially food intolerances and allergies are of importance in this setting. According to the article, 50–70% of patients with the so called irritable bowel syndrome have food intolerances. The fact that these can be confirmed as the trigger of the symptoms, and that adequate therapy can alleviate the symptoms, is being ignored and diagnostic testing is explicitly advised against. Histaminosis, which is extremely common and needs to be distinguished from genuine histamine intolerance, is not mentioned at all. The therapeutic recommendations merely aim at the symptoms, although very good causal therapeutic options are available for certain findings. In my opinion, great relief could be offered to many patients by looking at the bigger picture and uses adequate and appropriate stool diagnostics, even if only as the second step.

DOI: 10.3238/arztebl.2012.0447c

Dr. med. Eduard Rosler

Vinzenz von Paul Kliniken gGmbH, Marienhospital Stuttgart
 eduardrosler@vinzenz.de

Conflict of interest statement
The author declares that no conflict of interest exists.

1.
Häuser W, Layer P, Henningsen P, Kruis W: Functional bowel disorders in adults. Dtsch Arztebl Int 2012; 109(5): 83–94. VOLLTEXT
1.Häuser W, Layer P, Henningsen P, Kruis W: Functional bowel disorders in adults. Dtsch Arztebl Int 2012; 109(5): 83–94. VOLLTEXT