Background: Alterations in bowel habits is one of leading complaints among patients seen in the gastroenterology office. The increased volume of patient with complaints of chronic diarrhea, constipation or altered bowel habits continues to raise the question of the appropriateness and role for endoscopy as part of the diagnostic workup regarding these increasingly prevalent complaints. There is currently no clear evidence as to when endoscopy should be performed in evaluation of altered bowel habits. Many of the causative pathological processes resulting in altered bowel habits would not be detected on endoscopy or pathology and therefore the suspected diagnostic yield would be low. We suspect that the risk and cost associated with endoscopy relative to the low diagnostic yield should cause clinicians to focus efforts on other diagnostic measures prior to recommending or performing endoscopy for chronic diarrhea, chronic constipation, or altered bowel habits.