Should endoscopy be considered to evaluate acute infectious diarrhea?
Endoscopy should not be part of the routine evaluation of acute diarrhea, but can be considered in a select number of situations. Endoscopy may be useful to evaluate for IBD in patients with persistent bloody diarrhea and a negative infectious workup who do not respond to empiric therapy. When there is a strong suspicion for C. difficile and stool tests are negative or not available, flexible sigmoidoscopy may reveal characteristic pseudomembranes. Finally, endoscopy may also be useful for immunocompromised patients to evaluate for CMV colitis, which frequently requires a histologic diagnosis.