TY - JOUR T1 - Intractable diarrhoea with a lung neuroendocrine tumour JF - BMJ Supportive & Palliative Care JO - BMJ Support Palliat Care DO - 10.1136/bmjspcare-2021-003303 SP - bmjspcare-2021-003303 AU - Craig Gouldthorpe AU - Lucy Roth Y1 - 2021/09/03 UR - http://spcare.bmj.com/content/early/2021/09/03/bmjspcare-2021-003303.abstract N2 - Patients with neuroendocrine tumours are at risk of developing Carcinoid Syndrome. This may result in symptoms such as diarrhoea and flushing. We present a case of a lady with known Crohn’s disease and an atypical lung neuroendocrine tumour, who developed intractable diarrhoea. Multiple specific and non-specific pharmacological approaches failed to control her diarrhoea. Upon cessation of such treatments, her symptoms did not worsen. The case highlights the need for further research into the management of diarrhoea in this context, and the need to review and deprescribe ineffective treatments.Multiple causes of chronic diarrhoea exist, including gastrointestinal cancer or inflammation, pancreatic insufficiency, malabsorption and motility disorders.1 Diet, coeliac disease, medication and irritable bowel syndrome may also contribute.1 Following a focused history and examination, initial investigations may include inflammatory or infective markers in the blood and stool and serological tests for coeliac disease, hyperthyroidism and anaemia.1 Concerning features, warranting secondary care referral and further investigation, include unexplained change to bowel habit, unexplained weight loss and blood in the stool.1 Specific management approaches exist for identified pathologies. Examples include antibiotics for small bowel bacterial overgrowth and bile acid binders for bile acid malabsorption.2In cases of poor response to targeted treatment, or an unclear diagnosis, empirical treatment aimed at symptom management may be appropriate.2 Examples of non-specific approaches include loperamide, an opiate with mu receptor agonistic activity, and serotonin type 3 receptor antagonists, which slow gut transit and increase fluid absorption.2 More potent opioids may be used in severe cases.2 Treatments can also vary in specificity, such as cholestyramine for bile acid malabsorption which has … ER -