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Koletzko, S.; Otte, S.; Klucker, E. (2017): Stuhltests in der pädiatrischen Gastroenterologie. In: Monatsschrift Kinderheilkunde, Vol. 165, No. 7: pp. 572-580
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The visual inspection of stool to assess volume, consistency, color and smell has a long tradition in pediatric clinical practice. Stool is easy to sample and enables non-invasive investigations. There are four major indications for fecal tests: 1) suspected intestinal infections, 2) suspected malassimilation (e.g. maldigestion or malabsorption), 3) differentiating functional gastrointestinal disorders, such as irritable bowel syndrome or functional pain disorders or benign carbohydrate intolerances (e.g. lactose, sorbit, fructose malabsorption) from inflammatory bowel diseases and 4) monitoring for clearance of Helicobacter pylori infection after therapy. This overview gives a practical approach for useful fecal tests in pediatric gastroenterology addressing the indications and pitfalls. As the usefulness and validity of new diagnostic tests do not need to be proven for marketing, tests with unproven evidential value are frequently used with a high risk of giving misleading results. We discuss some of these inappropriate tests currently in use in Germany. False positive results may induce anxiety in patients, parents and the treating physician, while tests giving false negative results increase the risk for missed or delayed diagnosis. Tests with unproven evidential value may lead to further testing including invasive or potentially harmful investigations and increase of primary and secondary healthcare costs.