Chronic diarrhoea: the indications for lower GI endoscopy when functional bowel disease is suspected

We read with interest the 'Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, third Edition' by Arasaradnam et al.1 Compared with the second edition, the new guidance provides more detailed and specific content which will undoubtedly aid the investigation of chronic diarrhoea both in primary and secondary care. However, we would like to clarify the authors' position on the following.

On page 9 under 'Recommendations', the authors state 'In patients with typical symptoms of functional bowel disease, normal physical examination and normal screening blood and faecal tests (calprotectin), a positive diagnosis of IBS can be made (Grade of evidence level 2, Strength of recommendation strong).'

However, on the same page, they also state 'In younger patients (under 40 years) with a normal faecal calprotectin and in whom functional bowel disease is suspected, we recommend a flexible sigmoidoscopy with biopsy (Grade of evidence level 3, Strength...

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