Irritable bowel syndrome laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
Overview
The diagnosis of irritable bowel syndrome (IBS) is based on clinical symptoms and elimination of other organic gastrointestinal diseases. This is due to lack of definitive radiologic or laboratory diagnostic tests in IBS. If the history and physical examination are suggestive of IBS in the absence of alarm features, complete blood count, occult blood test, complete metabolic panel and ESR are usually normal. Additional tests may be costly and harmful in young patients with typical IBS symptoms, in the absence of alarm features. To determine the aggressiveness of the diagnostic evaluation, the American Gastroenterological Association has defined certain factors that must be considered such as degree of psychosocial impairment, age and sex of the patient, family history of colorectal cancer etc. In patients that require aggressive diagnostic evaluation, additional diseases such as Celiac disease, IBD, Clostridium difficile infection, giardiasis, lactase deficiency, bile salt malabsorption and colon cancer should be ruled out.
Laboratory Findings
- The diagnosis of irritable bowel syndrome (IBS) is based on clinical symptoms and elimination of other organic gastrointestinal diseases. This is due to lack of definitive radiologic or laboratory diagnostic tests in IBS.[1][2][3][4][5][6][7][8]
- If the history and physical examination are suggestive of IBS in the absence of alarm features, the following tests rule out organic causes:[9][10][11][12][13][14]
- CBC- normal in IBS
- Occult blood test- normal in IBS
- Complete metabolic panel- normal
- ESR- normal
- Additional tests may be costly and harmful in young patients with typical IBS symptoms, in the absence of alarm features.[15][16][11]
- To determine the aggressiveness of the diagnostic evaluation, the American Gastroenterological Association has defined certain factors that must be considered:[17][18][19]
- Degree of psychosocial impairment
- Age and sex of the patient
- Family history of colorectal cancer
- Prior diagnostic studies
- Duration of symptoms
- Change in symptoms over time
- In patients that require aggressive diagnostic evaluation, additional diseases need to be ruled out:[20][21][22][23][24]
- Celiac disease: Serological screening (antiendomysial antibodies) [25][26][27][28][29][26][20]
- IBD: [9][30][31][9][32][33][34]
- Inflammatory markers (ESR, C-reactive protein, plasma viscosity) are likely to be raised
- LFTs: decreased serum albumin
- Complete blood count shows iron deficiency anemia due to blood loss
- Fecal calprotectin
- Antibodies to a bacterial toxin produced by:[35][36][37][36]
- In IBS- diarrhea patients with recent antibiotic use, stool samples should be taken to exclude Clostridium difficile infection:[38]
- Giardiasis: Prevalent in developing countries
- Stool sample for microscopy
- Culture with specific request to look for ova, cyst and parasites
- Lactase deficiency: [39][23]
- Hydrogen breath test
- Evaluation after a 3-week lactose-free diet.
- Bile salt malabsorption:
- Biochemical testing of blood (e.g., testing for serum 7α-hydroxy-4-cholesten-3-one [C4, a bile acid precursor])
- Therapeutic trial of cholestyramine (bile acid sequestrant)
- Colon Cancer:
- In pain predominant IBS patients, biliary and pancreatic disease are excluded by:
- Other organic causes are suspected if lab investigations show the following:
- Complete blood count: evidence of anemia
- ESR raised
- Stool volume >200–300 mL/day
- Stool content: Blood and leukocytes
Role of biomarkers
- A biomarker may help in objective evaluation as a measure of normal biological processes such as transit through the colon, serotonin and bile acid metabolism. This may be highly prevalent in certain IBS subtypes.Antibodies to cytolethal distending toxin B (CdtB) and vinculin are some novel biomarkers that help in distinguishing irritable bowel syndrome with diarrhea (IBS-D) from other causes of diarrhea.[40][41][42][43][36][44][36][45][35]
References
- ↑ Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006). "Functional bowel disorders". Gastroenterology. 130 (5): 1480–91. doi:10.1053/j.gastro.2005.11.061. PMID 16678561.
- ↑ Drossman DA, Camilleri M, Mayer EA, Whitehead WE (2002). "AGA technical review on irritable bowel syndrome". Gastroenterology. 123 (6): 2108–31. doi:10.1053/gast.2002.37095. PMID 12454866.
- ↑ Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P (2007). "Guidelines on the irritable bowel syndrome: mechanisms and practical management". Gut. 56 (12): 1770–98. doi:10.1136/gut.2007.119446. PMC 2095723. PMID 17488783.
- ↑ Brandt LJ, Bjorkman D, Fennerty MB, Locke GR, Olden K, Peterson W, Quigley E, Schoenfeld P, Schuster M, Talley N (2002). "Systematic review on the management of irritable bowel syndrome in North America". Am. J. Gastroenterol. 97 (11 Suppl): S7–26. PMID 12425586.
- ↑ Yawn BP, Lydick E, Locke GR, Wollan PC, Bertram SL, Kurland MJ (2001). "Do published guidelines for evaluation of irritable bowel syndrome reflect practice?". BMC gastroenterology. 1: 11. PMID 11701092.
- ↑ Ford AC, Lacy BE, Talley NJ (2017). "Irritable Bowel Syndrome". N. Engl. J. Med. 376 (26): 2566–2578. doi:10.1056/NEJMra1607547. PMID 28657875.
- ↑ Weaver KR, Melkus GD, Henderson WA (2017). "Irritable Bowel Syndrome". Am J Nurs. 117 (6): 48–55. doi:10.1097/01.NAJ.0000520253.57459.01. PMID 28541989.
- ↑ De Ponti F (2004). "Pharmacology of serotonin: what a clinician should know". Gut. 53 (10): 1520–35. doi:10.1136/gut.2003.035568. PMC 1774227. PMID 15361507.
- ↑ 9.0 9.1 9.2 Menees SB, Powell C, Kurlander J, Goel A, Chey WD (2015). "A meta-analysis of the utility of C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and fecal lactoferrin to exclude inflammatory bowel disease in adults with IBS". Am. J. Gastroenterol. 110 (3): 444–54. doi:10.1038/ajg.2015.6. PMID 25732419.
- ↑ Thompson WG, Heaton KW, Smyth GT, Smyth C (2000). "Irritable bowel syndrome in general practice: prevalence, characteristics, and referral". Gut. 46 (1): 78–82. PMC 1727778. PMID 10601059.
- ↑ 11.0 11.1 Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM (2009). "An evidence-based position statement on the management of irritable bowel syndrome". Am. J. Gastroenterol. 104 Suppl 1: S1–35. doi:10.1038/ajg.2008.122. PMID 19521341.
- ↑ Vargues R (1967). "[The determination of complement]". Transfusion (Paris) (in French). 10 (3): 277–92. PMID 4169512.
- ↑ Begtrup LM, Engsbro AL, Kjeldsen J, Larsen PV, Schaffalitzky de Muckadell O, Bytzer P, Jarbøl DE (2013). "A positive diagnostic strategy is noninferior to a strategy of exclusion for patients with irritable bowel syndrome". Clin. Gastroenterol. Hepatol. 11 (8): 956–62.e1. doi:10.1016/j.cgh.2012.12.038. PMID 23357491.
- ↑ Lacy BE, Moreau JC (2016). "Diarrhea-predominant irritable bowel syndrome: Diagnosis, etiology, and new treatment considerations". J Am Assoc Nurse Pract. 28 (7): 393–404. doi:10.1002/2327-6924.12387. PMID 27436200.
- ↑ Fass R, Longstreth GF, Pimentel M, Fullerton S, Russak SM, Chiou CF, Reyes E, Crane P, Eisen G, McCarberg B, Ofman J (2001). "Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome". Arch. Intern. Med. 161 (17): 2081–8. PMID 11570936.
- ↑ Chey WD, Nojkov B, Rubenstein JH, Dobhan RR, Greenson JK, Cash BD (2010). "The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial". Am. J. Gastroenterol. 105 (4): 859–65. doi:10.1038/ajg.2010.55. PMC 2887227. PMID 20179696.
- ↑ Schmulson MW, Chang L (1999). "Diagnostic approach to the patient with irritable bowel syndrome". Am. J. Med. 107 (5A): 20S–26S. PMID 10588169.
- ↑ Svendsen JH, Munck LK, Andersen JR (1985). "Irritable bowel syndrome--prognosis and diagnostic safety. A 5-year follow-up study". Scand. J. Gastroenterol. 20 (4): 415–8. PMID 4023607.
- ↑ Sultan S, Malhotra A (2017). "Irritable Bowel Syndrome". Ann. Intern. Med. 166 (11): ITC81–ITC96. doi:10.7326/AITC201706060. PMID 28586906.
- ↑ 20.0 20.1 Cash BD, Rubenstein JH, Young PE, Gentry A, Nojkov B, Lee D, Andrews AH, Dobhan R, Chey WD (2011). "The prevalence of celiac disease among patients with nonconstipated irritable bowel syndrome is similar to controls". Gastroenterology. 141 (4): 1187–93. doi:10.1053/j.gastro.2011.06.084. PMC 3186819. PMID 21762658.
- ↑ Guagnozzi D, Arias Á, Lucendo AJ (2016). "Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders". Aliment. Pharmacol. Ther. 43 (8): 851–862. doi:10.1111/apt.13573. PMID 26913568.
- ↑ Hilpüsch F, Johnsen PH, Goll R, Valle PC, Sørbye SW, Abelsen B (2017). "Microscopic colitis: a missed diagnosis among patients with moderate to severe irritable bowel syndrome". Scand. J. Gastroenterol. 52 (2): 173–177. doi:10.1080/00365521.2016.1242025. PMID 27796144.
- ↑ 23.0 23.1 Cash BD, Schoenfeld P, Chey WD (2002). "The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review". Am. J. Gastroenterol. 97 (11): 2812–9. doi:10.1111/j.1572-0241.2002.07027.x. PMID 12425553.
- ↑ Kruis W, Thieme C, Weinzierl M, Schüssler P, Holl J, Paulus W (1984). "A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease". Gastroenterology. 87 (1): 1–7. PMID 6724251.
- ↑ Sanders DS, Carter MJ, Hurlstone DP, Pearce A, Ward AM, McAlindon ME, Lobo AJ (2001). "Association of adult coeliac disease with irritable bowel syndrome: a case-control study in patients fulfilling ROME II criteria referred to secondary care". Lancet. 358 (9292): 1504–8. doi:10.1016/S0140-6736(01)06581-3. PMID 11705563.
- ↑ 26.0 26.1 Ford AC, Chey WD, Talley NJ, Malhotra A, Spiegel BM, Moayyedi P (2009). "Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis". Arch. Intern. Med. 169 (7): 651–8. doi:10.1001/archinternmed.2009.22. PMID 19364994.
- ↑ Mehdi Z, Sakineh E, Mohammad F, Mansour R, Alireza A (2012). "Celiac disease: Serologic prevalence in patients with irritable bowel syndrome". J Res Med Sci. 17 (9): 839–42. PMC 3697208. PMID 23826010.
- ↑ Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA (2013). "ACG clinical guidelines: diagnosis and management of celiac disease". Am. J. Gastroenterol. 108 (5): 656–76, quiz 677. doi:10.1038/ajg.2013.79. PMC 3706994. PMID 23609613.
- ↑ Irvine AJ, Chey WD, Ford AC (2017). "Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis". Am. J. Gastroenterol. 112 (1): 65–76. doi:10.1038/ajg.2016.466. PMID 27753436.
- ↑ van Rheenen PF, Van de Vijver E, Fidler V (2010). "Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis". BMJ. 341: c3369. PMC 2904879. PMID 20634346.
- ↑ Waugh N, Cummins E, Royle P, Kandala NB, Shyangdan D, Arasaradnam R, Clar C, Johnston R (2013). "Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation". Health Technol Assess. 17 (55): xv–xix, 1–211. doi:10.3310/hta17550. PMC 4781415. PMID 24286461.
- ↑ Linedale EC, Andrews JM (2017). "Diagnosis and management of irritable bowel syndrome: a guide for the generalist". Med. J. Aust. 207 (7): 309–315. PMID 28954618.
- ↑ Spiller R, Major G (2016). "IBS and IBD - separate entities or on a spectrum?". Nat Rev Gastroenterol Hepatol. 13 (10): 613–21. doi:10.1038/nrgastro.2016.141. PMID 27667579.
- ↑ Manceau H, Chicha-Cattoir V, Puy H, Peoc'h K (2017). "Fecal calprotectin in inflammatory bowel diseases: update and perspectives". Clin. Chem. Lab. Med. 55 (4): 474–483. doi:10.1515/cclm-2016-0522. PMID 27658156.
- ↑ 35.0 35.1 Rezaie A, Park SC, Morales W, Marsh E, Lembo A, Kim JH, Weitsman S, Chua KS, Barlow GM, Pimentel M (2017). "Assessment of Anti-vinculin and Anti-cytolethal Distending Toxin B Antibodies in Subtypes of Irritable Bowel Syndrome". Dig. Dis. Sci. 62 (6): 1480–1485. doi:10.1007/s10620-017-4585-z. PMID 28451914.
- ↑ 36.0 36.1 36.2 36.3 Pimentel M, Morales W, Rezaie A, Marsh E, Lembo A, Mirocha J, Leffler DA, Marsh Z, Weitsman S, Chua KS, Barlow GM, Bortey E, Forbes W, Yu A, Chang C (2015). "Development and validation of a biomarker for diarrhea-predominant irritable bowel syndrome in human subjects". PLoS ONE. 10 (5): e0126438. doi:10.1371/journal.pone.0126438. PMC 4430499. PMID 25970536.
- ↑ Schmulson M, Balbuena R, Corona de Law C (2016). "Clinical experience with the use of anti-CdtB and anti-vinculin antibodies in patients with diarrhea in Mexico". Rev Gastroenterol Mex. 81 (4): 236–239. doi:10.1016/j.rgmx.2016.07.001. PMID 27681080.
- ↑ Barlow GM, Rezaie A, Lin E, Pimentel M (2016). "A definitive blood test for post-infectious irritable bowel syndrome?". Expert Rev Gastroenterol Hepatol. 10 (11): 1197–1199. doi:10.1080/17474124.2016.1242411. PMID 27682513.
- ↑ Parker TJ, Woolner JT, Prevost AT, Tuffnell Q, Shorthouse M, Hunter JO (2001). "Irritable bowel syndrome: is the search for lactose intolerance justified?". Eur J Gastroenterol Hepatol. 13 (3): 219–25. PMID 11293439.
- ↑ "Biomarkers and surrogate endpoints: preferred definitions and conceptual framework". Clin. Pharmacol. Ther. 69 (3): 89–95. 2001. doi:10.1067/mcp.2001.113989. PMID 11240971.
- ↑ Barbara G, Stanghellini V (2009). "Biomarkers in IBS: when will they replace symptoms for diagnosis and management?". Gut. 58 (12): 1571–5. doi:10.1136/gut.2008.169672. PMID 19923339.
- ↑ Camilleri M (2015). "Review article: biomarkers and personalised therapy in functional lower gastrointestinal disorders". Aliment. Pharmacol. Ther. 42 (7): 818–28. doi:10.1111/apt.13351. PMC 4558225. PMID 26264216.
- ↑ Sood R, Gracie DJ, Law GR, Ford AC (2015). "Systematic review with meta-analysis: the accuracy of diagnosing irritable bowel syndrome with symptoms, biomarkers and/or psychological markers". Aliment. Pharmacol. Ther. 42 (5): 491–503. doi:10.1111/apt.13283. PMID 26076071.
- ↑ Camilleri M, Shin A, Busciglio I, Carlson P, Acosta A, Bharucha AE, Burton D, Lamsam J, Lueke A, Donato LJ, Zinsmeister AR (2014). "Validating biomarkers of treatable mechanisms in irritable bowel syndrome". Neurogastroenterol. Motil. 26 (12): 1677–85. doi:10.1111/nmo.12421. PMC 4245393. PMID 25244349.
- ↑ Camilleri M, Halawi H, Oduyebo I (2017). "Biomarkers as a diagnostic tool for irritable bowel syndrome: where are we?". Expert Rev Gastroenterol Hepatol. 11 (4): 303–316. doi:10.1080/17474124.2017.1288096. PMID 28128666.