Fecesonderzoek bij patiënten met diarree

Schierenberg A, Broekhuizen BDL, de Wit NJ. Stool analysis in chronic diarrhoea. Huisarts Wet 2016;59(11):502-6. Diarrhoea is a common problem, with many potential causes. In most cases, it is caused by self-limiting gastroenteritis, for which further diagnostic investigations are not required. Although current guidelines advocate a conservative use of stool analysis, general practitioners (GPs) often request this expensive test. Stool analysis is only of clinical value if symptoms are severe or persistent, or if the patient is immunocompromised. In these cases, stool analysis makes it possible to start appropriate antibiotic treatment or to rule out severe disease. From a public health perspective, stool analysis may be necessary if an epidemic is suspected or if a patient works in the food industry or in healthcare. Overdiagnosis not only leads to high costs but also to unnecessary antibiotic use with adverse consequences to patients, such as the treatment of carriers and non-pathogenic parasites. Better adherence to guidelines can prevent this. Nowadays, most laboratories carry out stool analyses by means of polymerase chain reaction (PCR), which is faster, more convenient, and more accurate than culture and microscopy; however, it can also generate false-positive results with non-viable pathogens. Moreover, PCR tests often include multiple pathogens, so that positive results are sometimes reported for pathogens that were not suspected by the GP or for those of questionable pathogenicity.