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Diagnosing Irritable Bowel Syndrome

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Hello friends!  Let’s continue our conversation on Irritable Bowel Syndrome (IBS) today and focus on how the diagnosis is made and what testing, if any, is necessary. 

In the past, IBS was largely thought of as a diagnosis of exclusion, meaning that ALL other conditions needed to be tested for and ruled out prior to making the diagnosis. An updated approach now bases the diagnosis on a well-defined set of signs and symptoms with limited use of diagnostic testing.

In almost all cases, IBS can be accurately diagnosed by identifying specific symptoms, performing a physical examination, and pursuing appropriate testing if indicated. The classic symptoms of IBS include abdominal pain associated with a change in bowel habits – either frequency, consistency, or both.  Often, patients also experience abdominal bloating, distension, or gassiness. Most providers use something called the Rome IV Diagnostic Criteria for IBS, which includes the following:

  • Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with 2 or more of the following:
    • Related to defecation
    • Associated with a change in frequency of stool
    • Associated with a change in form (appearance of stool)
  • These criteria must have been met for the last 3 months with symptom onset at lease 6 months prior to diagnosis.

In the absence of “red flag” signs, a good history and exam may be all that is necessary to make the diagnosis. Sometimes there are signs and/or symptoms that may warrant a deeper investigation. If you are experiencing any of the following, further investigation may be appropriate.

  • Anemia
  • Symptom onset over age of 50
  • Bloody stools
  • Fever
  • Symptoms that occur at night and wake you up from sleep
  • Unintentional weight loss
  • Recent use of antibiotics
  • A family history of other GI diseases

Diagnostic testing needs to be individualized and based on each patient’s specific situation, as there is no cookie cutter approach in choosing which tests should be utilized. However, when an experienced health care provider determines the need for further testing, it may include:

  • Blood tests for anemia, thyroid disease + celiac disease
  • Stool tests
  • Colonoscopy
  • Barium enema
  • Psychological tests
  • Breath tests for lactose intolerance or bacterial overgrowth
  • Other tests based on specific aspects of a patients medical or family history

Thankfully for most patients, a good history of symptoms, a thorough exam, and a few basic tests are all that is required. This lack of invasive testing not only saves a patient possible discomfort, time, and money, but also allows us to change our focus from diagnosis to treatment much sooner. In doing so, we can help you feel better faster!

Meet me back next week as we finish out this series by diving into the treatment of IBS! 


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