Irritable bowel syndrome history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

History and symptoms

The symptoms of IBS are abdominal pain in association with frequent diarrhea, constipation, or a change in bowel habits.[1] The manifestation of symptoms is modulated by catastrophizing and somatization.[2][3]

The underlying biochemical causes of IBS are not well established. As such, there is no specific laboratory test which can be performed to diagnose this condition.[4] Diagnosis of IBS involves excluding conditions that produce with IBS-like symptoms and then following a procedure to categorize the patient's symptoms.

Because there are many causes of diarrhea and IBS-like symptoms, the American Gastroenterological Association has published a set of guidelines for tests to be performed to diagnose other conditions that may have symptoms similar to IBS. These include gastrointestinal infections, lactose intolerance and coeliac disease. Research has suggested that these guidelines are not always followed.[4] Once other causes have been excluded, the diagnosis of IBS is performed using a diagnostic algorithm. Well-known algorithms include the Manning Criteria, the Rome I Criteria, the Rome II Process, the Kruis Criteria, and studies have compared their reliability.[5] The more recent Rome III Process was published in 2006. Physicians may choose to use one of these criteria, or may use other guidelines based on their own experience and the patient's history. The algorithm may include additional tests to guard against misdiagnosis of other diseases as IBS. Such "red flag" symptoms may include weight loss, GI bleeding, anemia, or nocturnal symptoms. However, researchers have noted that red flag conditions may not always contribute to accuracy in diagnosis — for instance, as many as 31% of IBS patients have blood in their stool.[5]

The diagnostic algorithm identifies a name that can be applied to the patient's condition based on the combination of the patient's symptoms of diarrhea, abdominal pain, and constipation. For example, the statement "50% of returning travelers had developed functional diarrhea, while 25% had developed IBS" would mean that half the travelers had diarrhea while a quarter had diarrhea with abdominal pain. While some researchers believe this categorization system will help physicians understand IBS, others have questioned the value of the system and suggested that all IBS patients have the same underlying disease but with different symptoms.[6]

Misdiagnosis

Published research has demonstrated that some poor patient outcomes are due to treatable causes of diarrhea being misdiagnosed as IBS. Common examples include infectious diseases, celiac disease,[7] parasites,[8] food allergies[9] (though considered controversial), and lactose intolerance.[10] See the list of causes of diarrhea for other conditions which can cause diarrhea.

Coeliac disease in particular is often misdiagnosed as IBS:

Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases. In fact, sometimes celiac disease is confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, Crohn’s disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease is commonly underdiagnosed or misdiagnosed.[11]

Medical conditions that accompany IBS

Researchers have identified several medical conditions, or comorbidities, which appear with greater frequency in patients diagnosed with IBS.

Headache, Fibromyalgia, and Depression

A study of 97,593 individuals with IBS identified comorbidities as headache, fibromyalgia and depression.[12] Fibromyalgia has also been identified in other studies as a comorbidity of IBS.[13][14]

Inflammatory Bowel Disease

Some researchers have suggested that IBS is a type of low-grade inflammatory bowel disease.[15] Researchers have suggested that IBS and IBD are interrelated diseases,[16] noting that patients with IBD experience IBS-like symptoms when their IBD is in remission.[17][18] A 3-year study found that patients diagnosed with IBS were 16.3 times more likely to develop IBD during the study period.[19] Serum markers associated with inflammation have also been found in patients with IBS (see Causes).

Abdominal Surgery

A 2005 study published in Digestive Disease Science reported that IBS patients are 87% more likely to undergo abdominal and pelvic surgery, and three times more likely to undergo gallbladder surgery.[20] A study published in Gastroenterology came to similar conclusions, and also noted IBS patients were twice as likely to undergo hysterectomy.[21]

Endometriosis

One study has reported a statistically significant link between migraine headaches, IBS, and endometriosis.[22]

History and Symptoms

  • The diagnosis of IBS relies on recognition of gastrointestinal symptoms that wax and wane for and are exacerbated by psycho social stress. Diagnosis of IBS is based on on clinical symptoms and elimination of other organic gastrointestinal diseases. This is due to lack of definitive radio logic or laboratory diagnostic tests in IBS.
  • Cliical features of IBS include the presence of abdominal pain with alteration of bowel habits, without any systemic symptoms such as blood in stool, weight loss and fever. The onset of symptoms usually occurs during periods of stress and anxiety.
  • The most common symptoms of IBS include abdominal pain, altered bowel habits, bloating and flatulence.
  • Straining during defecation, urgency, sense of incomplete evacuation, mucus passage, bloating are also associated symptoms, not included under the diagnostic criteria.
  • The presence of other comorbidities including other functional disorders such as sleep disturbance, chronic fatigue, fibromyalgia favor IBS.
  • Alarm features or red flag symptoms/signs point towards other diagnoses. These features include family history of IBD or colon cancer, fever, recent antibiotic use, weight loss, blood in the stools and nocturnal awakening due to symptoms.
  • Symptoms concordant with the Rome criteria without red flag symptoms exclude organic causes such as lactose intolerance, celiac disease and IBD and help make a positive diagnosis of IBS while avoiding unnecessary investigations.

Abdominal Pain

  • Abdominal pain or discomfort is the major prerequisite for the diagnosis of IBS.
  • The abdominal pain onset is associated with a change in frequency or form of stool.
  • Characteristics of abdominal pain are as follows:
    • Site: variable location
    • Onset: sudden
    • Character: episodic and campy with a background of constant pain
    • Relieving factors: relief on defecation
    • Aggravating factors: eating, emotional stress, premenstrual and menstrual phases
    • Timing: pain is usually present during waking hours, nocturnal symptoms are usually present only in severe IBS.
    • Severity: variable (varies from mild to severe enough to impair Quality of Life)

Altered Bowel Habits

  • Altered bowel habits usually present as diarrhea alternating with constipation. One of these tends to be the predominant symptom in the patient.
    • Constipation predominant IBS: <3 bowel movements per week
      • Constipation in patients is initially episodic, but gradually becomes continuous and intractable to laxative treatment.
      • Patients develop weeks- months of constipation interrupted by diarrhea.
      • Patients have
        1. Hard stools
        2. Stools with narrow caliber, due to dehydration caused by colonic retention
        3. Sensation of incomplete evacuation
    • Diarrhea predominant IBS: >3 bowel movements per day
      • Patients have
        1. Loose stools in small volumes, aggravated by eating or emotional stress
        2. Stool volume of <200 ml
        3. Stool accompanied by mucus passage
        4. Absence of nocturnal diarrhea
        5. Absence of bleeding
        6. Absence of weight loss or malabsorption

Gas and flatulence

  • Patients develop distension of abdomen, flatulence, increased belching due to impaired transit and tolerance of gas loads in the intestine.
  • Patients have a tendency to develop reflux gas from the distal to proximal bowel which causes belching.

History

Patients with IBS may have a positive history of:

Common Symptoms

Common symptoms of IBS include:

  • Abdominal pain
  • Altered bowel habits
  • Bloating and flatulence

Less Common Symptoms

Less common symptoms of IBS include:

  • Straining during defecation
  • Urgency during defecation
  • Sense of incomplete evacuation
  • Mucus passage with stools

References

  1. ↑ Schmulson MW, Chang L (1999). "Diagnostic approach to the patient with irritable bowel syndrome". Am. J. Med. 107 (5A): 20S–26S. PMID 10588169.
  2. ↑ Jasper F, Egloff B, Roalfe A, Witthöft M (2015). "Latent structure of irritable bowel syndrome symptom severity". World J Gastroenterol. 21 (1): 292–300. doi:10.3748/wjg.v21.i1.292. PMC 4284348. PMID 25574104.
  3. ↑ van Tilburg MA, Palsson OS, Whitehead WE (2013). "Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model". J Psychosom Res. 74 (6): 486–92. doi:10.1016/j.jpsychores.2013.03.004. PMC 3673027. PMID 23731745.
  4. ↑ 4.0 4.1 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.
  5. ↑ 5.0 5.1 Fass R, Longstreth GF, Pimentel M; et al. (2001). "Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome". Arch. Intern. Med. 161 (17): 2081–8. PMID 11570936.
  6. ↑ Talley NJ (2006). "A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut?". Reviews in gastroenterological disorders. 6 (2): 72–8. PMID 16699476.
  7. ↑ Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS (2004). "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. PMID 15188167.
  8. ↑ Stark D, van Hal S, Marriott D, Ellis J, Harkness J. (2007). "Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis". Int J Parasitol. 31 (1): 11–20. PMID 17070814.
  9. ↑ Drisko; et al. (2006). "Treating Irritable Bowel Syndrome with a Food Elimination Diet Followed by Food Challenge and Probiotics". Journal of the American College of Nutrition. 25 (6): 514–22. PMID 17229899.
  10. ↑ Vernia P, Ricciardi MR, Frandina C, Bilotta T, Frieri G (1995). "Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet". The Italian journal of gastroenterology. 27 (3): 117–21. PMID 7548919.
  11. ↑ http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/ - The United States National Institutes of Health Celiac Disease Page
  12. ↑ Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA (2006). "Migraine,fibromyalgia, and depression among people with IBS: a prevalence study". BMC gastroenterology. 6: 26. doi:10.1186/1471-230X-6-26. PMID 17007634.
  13. ↑ Kurland JE, Coyle WJ, Winkler A, Zable E (2006). "Prevalence of irritable bowel syndrome and depression in fibromyalgia". Dig. Dis. Sci. 51 (3): 454–60. doi:10.1007/s10620-006-3154-7. PMID 16614951.
  14. ↑ Frissora CL, Koch KL (2005). "Symptom overlap and comorbidity of irritable bowel syndrome with other conditions". Current gastroenterology reports. 7 (4): 264–71. PMID 16042909.
  15. ↑ Bercik P, Verdu EF, Collins SM (2005). "Is irritable bowel syndrome a low-grade inflammatory bowel disease?". Gastroenterol. Clin. North Am. 34 (2): 235–45, vi–vii. doi:10.1016/j.gtc.2005.02.007. PMID 15862932.
  16. ↑ Quigley EM (2005). "Irritable bowel syndrome and inflammatory bowel disease: interrelated diseases?". Chinese journal of digestive diseases. 6 (3): 122–32. doi:10.1111/j.1443-9573.2005.00202.x. PMID 16045602.
  17. ↑ Simrén M, Axelsson J, Gillberg R, Abrahamsson H, Svedlund J, Björnsson ES (2002). "Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors". Am. J. Gastroenterol. 97 (2): 389–96. PMID 11866278.
  18. ↑ Minderhoud IM, Oldenburg B, Wismeijer JA, van Berge Henegouwen GP, Smout AJ (2004). "IBS-like symptoms in patients with inflammatory bowel disease in remission; relationships with quality of life and coping behavior". Dig. Dis. Sci. 49 (3): 469–74. PMID 15139501.
  19. ↑ García Rodríguez LA, Ruigómez A, Wallander MA, Johansson S, Olbe L (2000). "Detection of colorectal tumor and inflammatory bowel disease during follow-up of patients with initial diagnosis of irritable bowel syndrome". Scand. J. Gastroenterol. 35 (3): 306–11. PMID 10766326.
  20. ↑ Cole JA, Yeaw JM, Cutone JA; et al. (2005). "The incidence of abdominal and pelvic surgery among patients with irritable bowel syndrome". Dig. Dis. Sci. 50 (12): 2268–75. doi:10.1007/s10620-005-3047-1. PMID 16416174.
  21. ↑ Longstreth GF, Yao JF (2004). "Irritable bowel syndrome and surgery: a multivariable analysis". Gastroenterology. 126 (7): 1665–73. PMID 15188159.
  22. ↑ Tietjen GE, Bushnell CD, Herial NA, Utley C, White L, Hafeez F (2007). "Endometriosis is associated with prevalence of comorbid conditions in migraine". Headache. 47 (7): 1069–78. doi:10.1111/j.1526-4610.2007.00784.x. PMID 17635599.
  23. ↑ Devanarayana NM, Mettananda S, Liyanarachchi C, Nanayakkara N, Mendis N, Perera N, Rajindrajith S (2011). "Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress". J. Pediatr. Gastroenterol. Nutr. 53 (6): 659–65. doi:10.1097/MPG.0b013e3182296033. PMID 21697745.
  24. ↑ 24.0 24.1 Qin HY, Cheng CW, Tang XD, Bian ZX (2014). "Impact of psychological stress on irritable bowel syndrome". World J. Gastroenterol. 20 (39): 14126–31. doi:10.3748/wjg.v20.i39.14126. PMC 4202343. PMID 25339801.
  25. ↑ 25.0 25.1 Bharucha AE, Chakraborty S, Sletten CD (2016). "Common Functional Gastroenterological Disorders Associated With Abdominal Pain". Mayo Clin. Proc. 91 (8): 1118–32. doi:10.1016/j.mayocp.2016.06.003. PMC 4985027. PMID 27492916.
  26. ↑ Ibrahim NK (2016). "A systematic review of the prevalence and risk factors of irritable bowel syndrome among medical students". Turk J Gastroenterol. 27 (1): 10–6. doi:10.5152/tjg.2015.150333. PMID 26674980.
  27. ↑ 27.0 27.1 27.2 Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA (2006). "Migraine, fibromyalgia, and depression among people with IBS: a prevalence study". BMC Gastroenterol. 6: 26. doi:10.1186/1471-230X-6-26. PMC 1592499. PMID 17007634.
  28. ↑ Hausteiner-Wiehle C, Henningsen P (2014). "Irritable bowel syndrome: relations with functional, mental, and somatoform disorders". World J. Gastroenterol. 20 (20): 6024–30. doi:10.3748/wjg.v20.i20.6024. PMC 4033442. PMID 24876725.
  29. ↑ 29.0 29.1 Major G, Spiller R (2014). "Irritable bowel syndrome, inflammatory bowel disease and the microbiome". Curr Opin Endocrinol Diabetes Obes. 21 (1): 15–21. doi:10.1097/MED.0000000000000032. PMC 3871405. PMID 24296462.
  30. ↑ Ceuleers H, Van Spaendonk H, Hanning N, Heirbaut J, Lambeir AM, Joossens J, Augustyns K, De Man JG, De Meester I, De Winter BY (2016). "Visceral hypersensitivity in inflammatory bowel diseases and irritable bowel syndrome: The role of proteases". World J. Gastroenterol. 22 (47): 10275–10286. doi:10.3748/wjg.v22.i47.10275. PMC 5175241. PMID 28058009.
  31. ↑ Halliez MC, Buret AG (2013). "Extra-intestinal and long term consequences of Giardia duodenalis infections". World J. Gastroenterol. 19 (47): 8974–85. doi:10.3748/wjg.v19.i47.8974. PMC 3870550. PMID 24379622.
  32. ↑ Simrén M, Barbara G, Flint HJ, Spiegel BM, Spiller RC, Vanner S, Verdu EF, Whorwell PJ, Zoetendal EG (2013). "Intestinal microbiota in functional bowel disorders: a Rome foundation report". Gut. 62 (1): 159–76. doi:10.1136/gutjnl-2012-302167. PMC 3551212. PMID 22730468.
  33. ↑ Jeffery IB, Quigley EM, Öhman L, Simrén M, O'Toole PW (2012). "The microbiota link to irritable bowel syndrome: an emerging story". Gut Microbes. 3 (6): 572–6. doi:10.4161/gmic.21772. PMC 3495796. PMID 22895081.
  34. ↑ Ibarra C, Herrera V, Pérez de Arce E, Gil LC, Madrid AM, Valenzuela L, Beltrán CJ (2016). "[Parasitosis and irritable bowel syndrome]". Rev Chilena Infectol (in Spanish; Castilian). 33 (3): 268–74. doi:10.4067/S0716-10182016000300003. PMID 27598274.
  35. ↑ Giddings SL, Stevens AM, Leung DT (2016). "Traveler's Diarrhea". Med. Clin. North Am. 100 (2): 317–30. doi:10.1016/j.mcna.2015.08.017. PMC 4764790. PMID 26900116.
  36. ↑ Keithlin J, Sargeant J, Thomas MK, Fazil A (2014). "Systematic review and meta-analysis of the proportion of Campylobacter cases that develop chronic sequelae". BMC Public Health. 14: 1203. doi:10.1186/1471-2458-14-1203. PMC 4391665. PMID 25416162.
  37. ↑ Grover M (2014). "Role of gut pathogens in development of irritable bowel syndrome". Indian J. Med. Res. 139 (1): 11–8. PMC 3994726. PMID 24604037.
  38. ↑ Keithlin J, Sargeant J, Thomas MK, Fazil A (2014). "Chronic sequelae of E. coli O157: systematic review and meta-analysis of the proportion of E. coli O157 cases that develop chronic sequelae". Foodborne Pathog. Dis. 11 (2): 79–95. doi:10.1089/fpd.2013.1572. PMC 3925333. PMID 24404780.
  39. ↑ Connor BA, Riddle MS (2013). "Post-infectious sequelae of travelers' diarrhea". J Travel Med. 20 (5): 303–12. doi:10.1111/jtm.12049. PMID 23992573.
  40. ↑ Ghoshal UC, Shukla R, Ghoshal U (2017). "Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy". Gut Liver. 11 (2): 196–208. doi:10.5009/gnl16126. PMC 5347643. PMID 28274108.
  41. ↑ Gallo A, Passaro G, Gasbarrini A, Landolfi R, Montalto M (2016). "Modulation of microbiota as treatment for intestinal inflammatory disorders: An uptodate". World J. Gastroenterol. 22 (32): 7186–202. doi:10.3748/wjg.v22.i32.7186. PMC 4997632. PMID 27621567.
  42. ↑ Distrutti E, Monaldi L, Ricci P, Fiorucci S (2016). "Gut microbiota role in irritable bowel syndrome: New therapeutic strategies". World J. Gastroenterol. 22 (7): 2219–41. doi:10.3748/wjg.v22.i7.2219. PMC 4734998. PMID 26900286.
  43. ↑ Shreiner AB, Kao JY, Young VB (2015). "The gut microbiome in health and in disease". Curr. Opin. Gastroenterol. 31 (1): 69–75. doi:10.1097/MOG.0000000000000139. PMC 4290017. PMID 25394236.
  44. ↑ Goodwin L, White PD, Hotopf M, Stansfeld SA, Clark C (2013). "Life course study of the etiology of self-reported irritable bowel syndrome in the 1958 British birth cohort". Psychosom Med. 75 (2): 202–10. doi:10.1097/PSY.0b013e31827c351b. PMID 23324872.
  45. ↑ Makker J, Chilimuri S, Bella JN (2015). "Genetic epidemiology of irritable bowel syndrome". World J. Gastroenterol. 21 (40): 11353–61. doi:10.3748/wjg.v21.i40.11353. PMC 4616211. PMID 26525775.
  46. ↑ Mulak A, Taché Y, Larauche M (2014). "Sex hormones in the modulation of irritable bowel syndrome". World J. Gastroenterol. 20 (10): 2433–48. doi:10.3748/wjg.v20.i10.2433. PMC 3949254. PMID 24627581.
  47. ↑ Mawe GM, Coates MD, Moses PL (2006). "Review article: intestinal serotonin signalling in irritable bowel syndrome". Aliment. Pharmacol. Ther. 23 (8): 1067–76. doi:10.1111/j.1365-2036.2006.02858.x. PMID 16611266.
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  51. ↑ Vehof J, Zavos HM, Lachance G, Hammond CJ, Williams FM (2014). "Shared genetic factors underlie chronic pain syndromes". Pain. 155 (8): 1562–8. doi:10.1016/j.pain.2014.05.002. PMID 24879916.
  52. ↑ Chirila I, Petrariu FD, Ciortescu I, Mihai C, Drug VL (2012). "Diet and irritable bowel syndrome". J Gastrointestin Liver Dis. 21 (4): 357–62. PMID 23256117.

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