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    8 gut reactions to common problems

    Here is helpful advice gleaned from my experiences with C diff, diarrhea, colic, reflux, and other things gastroenterological.

    1. The BRAT diet (bananas, rice, apples, tea, and toast is what I was taught it meant) is still popular among parents and physicians for treating diarrhea, but I am not aware of any good evidence that it is effective. These BRAT foods are fine for diarrhea, but they do not need to be the mainstay. Unless a child clearly has a significant lactase deficiency, I recommend a regular diet, including dairy, except I stay away from fruit juice. The diarrhea may get worse before it gets better, but the improved diet leads to a quicker response.

    2. Calprotectin of the stool is a useful test for inflammation1; it is the C-reactive protein of stool. However, it is important to remember that the value can be increased by protein pump inhibitors and histamine 2 blockers.

    3. Do not test for Helicobacter pylori serology in children2; the test is prone to false negatives and positives. Stool testing is better, if needed. Even then, do not test in children with functional abdominal pain as there are many false positives.

    4. As with biopsy, one must be on a gluten-containing diet at the time of testing for a tissue transglutaminase antibodies (tTG)-immunoglobulin (Ig)A result to be accurately interpreted for celiac disease.3

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