Diarrhoea, acute or chronic, is a common gastrointestinal symptom in healthcare. In most cases, acute diarrhoea in healthy individuals requires limited diagnostic and therapeutic efforts, except for the replacement of fluid electrolytes, and stool culture in severe occurrences. Acute diarrhoea is often self-limiting due to short-lived reactions to food intake and bacterial or viral infections. However, diarrhoea can persist and fulfil definitions of chronicity when a month or more has passed since the onset. Here we discuss some basic mistakes that should be avoided when managing unexplained non-bloody diarrhoea that persists beyond the acute setting. In this context, the term 'unexplained' refers to a patient without apparent alarm features and where initial consultations have failed at making a diagnosis. We used an evidence-based approach and included aspects predominantly based on clinical experience when appropriate.

Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.¹ Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.² Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.³

The relationship between nutrition and inflammatory bowel disease (IBD) has been an area of substantial interest and research for many decades now. Evidence-based nutritional strategies are being utilised as a key part of the therapeutic armamentarium in Crohn’s disease for both induction and maintenance, as primary and adjuvant treatment methods. Exclusive enteral nutrition, for instance, is well established in the treatment of paediatric IBD and adult centres are increasingly incorporating it into treatment models as an effective, drug-free alternative.  The role for partial enteral nutrition and Crohn’s disease specific diets are also being more clearly elucidated. Used appropriately, and through engagement with dietetic support services, nutritional therapies can not only achieve the IBD treatment ‘targets’ but serve to optimise other vital aspects of care, such as growth, bone health, body composition and overall patient well-being. Here we discuss some of the mistakes that are frequently made in the area of nutritional management of IBD. The discussion is evidence based, with key references incorporated for further analysis beyond the scope of this article, and combines several decades of leading clinical and research experience in the area of nutrition and IBD from the authors.