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* The diagnosis of [[Irritable bowel syndrome|IBS]] is based on clinical [[Symptom|symptoms]] and elimination of other organic [[Gastrointestinal tract|gastrointestinal]] diseases. This is due to lack of definitive [[Radiologic sign|radiologic]] or [[Medical laboratory|laboratory]] diagnostic tests in [[Irritable bowel syndrome|IBS]].<ref name="pmid16678561">{{cite journal |vauthors=Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC |title=Functional bowel disorders |journal=Gastroenterology |volume=130 |issue=5 |pages=1480–91 |year=2006 |pmid=16678561 |doi=10.1053/j.gastro.2005.11.061 |url=}}</ref><ref name="pmid12454866">{{cite journal |vauthors=Drossman DA, Camilleri M, Mayer EA, Whitehead WE |title=AGA technical review on irritable bowel syndrome |journal=Gastroenterology |volume=123 |issue=6 |pages=2108–31 |year=2002 |pmid=12454866 |doi=10.1053/gast.2002.37095 |url=}}</ref><ref name="pmid17488783">{{cite journal |vauthors=Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P |title=Guidelines on the irritable bowel syndrome: mechanisms and practical management |journal=Gut |volume=56 |issue=12 |pages=1770–98 |year=2007 |pmid=17488783 |pmc=2095723 |doi=10.1136/gut.2007.119446 |url=}}</ref><ref name="pmid12425586">{{cite journal |vauthors=Brandt LJ, Bjorkman D, Fennerty MB, Locke GR, Olden K, Peterson W, Quigley E, Schoenfeld P, Schuster M, Talley N |title=Systematic review on the management of irritable bowel syndrome in North America |journal=Am. J. Gastroenterol. |volume=97 |issue=11 Suppl |pages=S7–26 |year=2002 |pmid=12425586 |doi= |url=}}</ref><ref name="YAWN_2001">{{cite journal |author=Yawn BP, Lydick E, Locke GR, Wollan PC, Bertram SL, Kurland MJ|title=Do published guidelines for evaluation of irritable bowel syndrome reflect practice? |journal=BMC gastroenterology |volume=1|issue= |pages=11 |year=2001 |pmid=11701092 |doi=}}</ref> | * The diagnosis of [[Irritable bowel syndrome|IBS]] is based on clinical [[Symptom|symptoms]] and elimination of other organic [[Gastrointestinal tract|gastrointestinal]] diseases. This is due to lack of definitive [[Radiologic sign|radiologic]] or [[Medical laboratory|laboratory]] diagnostic tests in [[Irritable bowel syndrome|IBS]].<ref name="pmid16678561">{{cite journal |vauthors=Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC |title=Functional bowel disorders |journal=Gastroenterology |volume=130 |issue=5 |pages=1480–91 |year=2006 |pmid=16678561 |doi=10.1053/j.gastro.2005.11.061 |url=}}</ref><ref name="pmid12454866">{{cite journal |vauthors=Drossman DA, Camilleri M, Mayer EA, Whitehead WE |title=AGA technical review on irritable bowel syndrome |journal=Gastroenterology |volume=123 |issue=6 |pages=2108–31 |year=2002 |pmid=12454866 |doi=10.1053/gast.2002.37095 |url=}}</ref><ref name="pmid17488783">{{cite journal |vauthors=Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P |title=Guidelines on the irritable bowel syndrome: mechanisms and practical management |journal=Gut |volume=56 |issue=12 |pages=1770–98 |year=2007 |pmid=17488783 |pmc=2095723 |doi=10.1136/gut.2007.119446 |url=}}</ref><ref name="pmid12425586">{{cite journal |vauthors=Brandt LJ, Bjorkman D, Fennerty MB, Locke GR, Olden K, Peterson W, Quigley E, Schoenfeld P, Schuster M, Talley N |title=Systematic review on the management of irritable bowel syndrome in North America |journal=Am. J. Gastroenterol. |volume=97 |issue=11 Suppl |pages=S7–26 |year=2002 |pmid=12425586 |doi= |url=}}</ref><ref name="YAWN_2001">{{cite journal |author=Yawn BP, Lydick E, Locke GR, Wollan PC, Bertram SL, Kurland MJ|title=Do published guidelines for evaluation of irritable bowel syndrome reflect practice? |journal=BMC gastroenterology |volume=1|issue= |pages=11 |year=2001 |pmid=11701092 |doi=}}</ref> | ||
* If the history and physical exam are suggestive of IBS in the absence of alarm features, the following tests rule out organic causes by 97 percent: <ref name="pmid25732419">{{cite journal |vauthors=Menees SB, Powell C, Kurlander J, Goel A, Chey WD |title=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 |journal=Am. J. Gastroenterol. |volume=110 |issue=3 |pages=444–54 |year=2015 |pmid=25732419 |doi=10.1038/ajg.2015.6 |url=}}</ref> | * If the history and physical exam are suggestive of IBS in the absence of alarm features, the following tests rule out organic causes by 97 percent:<ref name="pmid25732419">{{cite journal |vauthors=Menees SB, Powell C, Kurlander J, Goel A, Chey WD |title=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 |journal=Am. J. Gastroenterol. |volume=110 |issue=3 |pages=444–54 |year=2015 |pmid=25732419 |doi=10.1038/ajg.2015.6 |url=}}</ref> | ||
** CBC- normal in IBS | ** CBC- normal in IBS | ||
** Occult blood test- normal in IBS | ** Occult blood test- normal in IBS | ||
Revision as of 22:39, 7 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
OR
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
OR
[Test] is usually normal among patients with [disease name].
OR
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
OR
There are no diagnostic laboratory findings associated with [disease name].
Laboratory Findings
- The diagnosis of 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]
- If the history and physical exam are suggestive of IBS in the absence of alarm features, the following tests rule out organic causes by 97 percent:[6]
- 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 symtoms, 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:
- 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:[7]
- Celiac disease: Serological screening (antiendomysial antibodies)
- IBD:
- Inflammatory markers (ESR, C-reactive protein, plasma viscosity) are likely to be raised
- LFTs: decreased serum albumin
- Complete blood count shows IDA due to blood loss
- Fecal calprotectin
- antibodies to a bacterial toxin produced by:
- Campylobacter jejuni
- vinculin
- Giardiasis: prevalent in developing countries
- stool sample for microscopy
- culture with specific request to look for ova, cyst and parasites
- Lactase deficiency:
- 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:
- Complete blood-count
- Erythrocyte sedimentation rate
- C reactive protein
- Thyroid function test
- Liver function
- Stool examination
- Stool culture
- 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
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.
- ↑ 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.
- ↑ 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.