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April 18, 1977

Diagnosis in a Patient With Acute Diarrhea

JAMA. 1977;237(16):1692. doi:10.1001/jama.1977.03270430034009

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To the Editor.—  We read with interest the article by Satterwhite and DuPont (236:2662,1976), which discussed the management of acute diarrhea. We must object, however, to the algorithm proposed for diagnosis. Following this algorithm, proctoscopy would only be performed if "yes" is the response to the question: "Is patient taking a drug that causes diarrhea?" If there is a negative response to that question, then the workup proceeds without proctoscopy.Proctosigmoidoscopy is an integral part of the workup of any patient with diarrhea, especially if that patient is hospitalized. As stated by the authors, it is of value in detecting drug-induced colitis, but it is also invaluable in detecting infection with Entamoeba histolytica and in evaluating the spectrum of inflammatory bowel disease, radiation colitis, and neoplasms. As any of these may involve acute diarrhea, we feel the algorithm does not allow proctosigmoidoscopy its proper place.If the algorithm is meant