To the Editor:

The presence of dark stools can be a cause of consternation to the patient and is made more anxiety-producing when accompanied by abdominal pain or other discomfort. The causes of melena are well outlined in several reviews, along with the usual non-heme causes of black stools, including iron, bismuth, charcoal, licorice, and certain fruits.

To this list should be added the colorings present in chocolate sandwich cookies. In several independent tests (with myself and several volunteers as experimental subjects), the presence of black stools approximately 18 to 24 hours after ingestion of 225 to 450 g of chocolate sandwich cookies has been observed. Variation in brand of cookie did not change the stool character. Testing with other types of cookie (oatmeal, peanut butter, and chocolate chip, among others) has not resulted in the same stool findings, although abdominal pain or nausea or both appear to be equally frequent associations.

This phenomenon may be on the increase because of shifts in U.S. dietary habits, so elicitation of a good dietary history in cases of black stools and abdominal pain should be pursued. Inasmuch as "cookie-induced pseudomelena" is both unprofessional sounding and too appropriately descriptive, a suggested name for this entity is "Hydrox fecalis."

Stephen Sulkes, M.D.
Monroe Developmental Disabilities
Rochester, N.Y.