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PRACTICE: Sonia Saxena, Sally G Mitton, and Richard Pollok Chronic diarrhoea in a teenager BMJ 2008; 337: a430 [Full text]

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chronic diarrhoea in a teenager- more history and investigations?

rafeeq muhammed   (28 September 2008)

Don't forget the lesson: chewing gum can cause diarrhoea

Nicola D Jones   (9 October 2008)

chronic diarrhoea in a teenager- more history and investigations? 28 September 2008
rafeeq muhammed, specialist registrar in paediatric gastroenterology Birmingham childrens hospital, Birmingham, UK Send response to journal: Re: chronic diarrhoea in a teenager- more history and investigations?	I would like to raise some points which has not been discussed by the authors in their article titled chronic diarrhoea in a teenager (1). It is important to obtain the history of night time diarrhoea or nocturnal abdominal pain, because if these are present that points more towards an organic cause rather than a functional aetiology. A fraction of children preseting with diarrhoea, in fact will be having 'overflow diarrhoea' secondary to chronic constpation and this can be differentiated by a careful history of bowel habits. Authors have given a comprehensive list of investigations that can be organised at primary care level, but it will also be useful to perform stool elastase (to rule out exocrine pancreatic insufficiency) and faecal alfa one antitrypsin ( to rule out protein losing enteropathy). References 1.Chronic diarrhoea in a teenager: S.Saxena, SG.Mitton, R.Pollock BMJ 2008; 337: a430 Competing interests: None declared
Don't forget the lesson: chewing gum can cause diarrhoea 9 October 2008
Nicola D Jones, GP Retainee Roseneath Medical Practice CH7 2JL Send response to journal: Re: Don't forget the lesson: chewing gum can cause diarrhoea	I feel that we should not forget the possibility of diarrhoea in a teenager being caused by chewing gum or other sources of sorbitol. Readers will recall two cases of diarrhoea with weight loss reported earlier this year as a BMJ “lesson of the week”. Dr Nicola Jones References: 1. Chronic diarrhoea in a teenager. Saxena S, Mitton SG, Pollok R. BMJ 2008; 337: a430 (14 July) 2. Lesson of the Week: Severe weight loss caused by chewing gum. Bauditz J, Norman K, Biering H, Lochs H, Pirlich M. BMJ 2008;336:96-97 (12 January) Competing interests: None declared