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Faecal analysis in Australia

The recent article by Lust et al. raises the very contentious issue regarding the retention of the 72-h faecal fat testing. Some of the issues discussed deserve further amplification and input from the laboratory perspective. The 29% response rate is hardly representative of the gastroenterological community where responders are more likely to be academic, investigation oriented and perhaps have a special interest in faecal fat testing. The critical problem with this test, however, is the imprecision or lack of reproducibility. This imprecision is affected by many factors that have remained beyond the control of the laboratory. Optimal fat intake in preparation for the test is often lacking because of the time pressure on the clinician’s part. The addition of a dietician would additionally be costly and add another level of complexity to the process.Many laboratories assistwith this process by giving out instruction leaflets regarding the optimal fat consumption before the test, but they do not extend beyond this. The patients’ compliance rate with advice is generally poor because in truly abnormal cases, many patients reduce the fat intake to avoid symptom recurrence,whichon its own,negates theneed for the test in the first place. This imprecision is further compounded by the patients’ view that this test is cumbersome and unhygienic, resulting in many insurmountable issues. They include an incomplete collection, especially in the elderly and obese groups and an inadequate size of the container, especially in high-volume, profuse diarrhoea and sample storage. If not refrigerated, the samples will denature at room temperature before being returned to the laboratory. These problems are further compounded in children where collections are evenmore inaccurate, contaminated with urine and subjected to body heat denaturation Letters to the Editor