When should I consider referring a patient with dysentery for specialist gastrointestinal assessment?

Consider referring a patient with dysentery for specialist gastrointestinal assessment if any of the following are present:

• Presence of blood and/or mucus in the stool, which may indicate a diagnosis other than simple gastroenteritis and warrants further investigation ¹.
• Symptoms suggesting clinical dehydration or shock, or if the patient is at high risk of dehydration, as these require urgent assessment and possible secondary care involvement ¹.
• Failure of diarrhoea to improve by day 7, or uncertainty about the diagnosis, prompting stool microbiological investigations and possible specialist referral ¹.
• Signs or symptoms suggesting an alternative serious diagnosis, such as severe or localized abdominal pain, altered conscious state, or systemic signs like fever above 39°C in older children, which may require specialist input ¹.
• In adults, presence of red flag symptoms such as signs and symptoms of cancer or inflammatory bowel disease markers should prompt referral to secondary care ³.

In summary, referral is indicated when dysentery is accompanied by red flag symptoms, systemic illness, failure to improve, or diagnostic uncertainty, to ensure appropriate specialist gastrointestinal assessment and management ¹,³.