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April 18, 1977

Diagnosis in a Patient With Acute Diarrhea-Reply

JAMA. 1977;237(16):1692. doi:10.1001/jama.1977.03270430034010

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We thank Drs Morris and Chiprut for their helpful comments and are in complete agreement that proctoscopy is a valuable tool in the examination of a wide spectrum of patients with diarrhea. Our algorithm focused sharply on the patient with infectious diarrhea of less than two weeks' duration, and purposely excluded those with more protracted illnesses. Proctoscopy is useful in establishing the presence of colitis, which may be found in patients with shigellosis, salmonellosis or amebiasis. We feel that the fecal leukocyte test, when combined with stool cultures, is a reasonable way to establish the diagnosis of shigellosis or salmonellosis. Sampling an ulcer through a proctoscope will increase the yield of Entamoeba histolytica in patients with amebiasis.

In the patient with chronic or intermittent diarrhea, proctosigmoidoscopy may be the key in the diagnosis of inflammatory bowel disease, radiation colitis, or neoplasm. In this patient, other tests may be