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:
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
- This is due to lack of definitive radio logic or laboratory diagnostic tests in IBS.There are no diagnostic laboratory findings associated with [disease name].
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.[1][2][3][4][5]The hallmark of IBS is abdominal pain. A positive history of stress, anxiety, depression, panic disorders, gastrointestinal disorders such as IBD and acute GI infection predispose individuals to IBS. The most common symptoms of IBS include presence of abdominal pain and alteration of bowel habits. Less common symptoms of IBS include gas, flatulence and upper GI symptoms such as heartburn, nausea, dyspepsia and vomiting.
When 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
CBC- normal
Occult blood test- normal
Complete metabolic panel- normal
ESR- normal
To rule out organic causes completely, the following investigations may be done:
Serological screening for Celiac disease
Inflammatory markers(ESR, C-reactive protein, plasma viscosity) are likely to be raised in IBD. LFTs- decreased serum albumin, full blood count- IDA due to blood loss
Giardiasis- stool sample for microscopy
and culture with specific request to look for ova, cyst and parasites( developing countries)
Typical IBS symptoms- no alarm signs and symptoms, Unnecessary investigations may be costly and even harmful.
Laboratory features that argue against IBS include evidence of anemia, elevated sedimentation rate, presence of leukocytes or blood in stool, and stool volume >200–300 mL/d. These findings would necessitate other diagnostic considerations
The American Gastroenterological Association has delineated factors to be considered when determining the aggressiveness of the diagnostic evaluation. These include the duration of symptoms, the change in symptoms over time, the age and sex of the patient, the referral status of the patient, prior diagnostic studies, a family history of colorectal malignancy, and the degree of psychosocial dysfunction. Thus, a younger individual
with mild symptoms requires a minimal diagnostic evaluation,while an older person or an individual with rapidly progressive symptoms should undergo a more thorough exclusion of organic disease.
This disorder should be screened for with
antiendomysial antibodies. A full blood count, renal and
liver function tests, thyroid function testing, and
investigation of stool sample for parasites all have very
low yields but are inexpensive.109
Most patients should have a complete blood count and
sigmoidoscopic examination; in addition, stool specimens should
be examined for ova and parasites in those who have diarrhea.
In patients with persistent diarrhea not responding to simple
antidiarrheal agents, a sigmoid colon biopsy should be performed
to rule out microscopic colitis.
In those age >40 years, an aircontrast
barium enema or colonoscopy should also be performed.
If the main symptoms are diarrhea and increased gas, the possibility
of lactase deficiency should be ruled out with a hydrogen breath test
or with evaluation after a 3-week lactose-free diet.
Some patients with IBS-D may have undiagnosed celiac sprue. Because the symptoms
of celiac sprue respond to a gluten-free diet, testing for celiac
sprue in IBS may prevent years of morbidity and attendant expense.
Decision-analysis studies show that serology testing for celiac sprue
in patients with IBS-D has an acceptable cost when the prevalence
of celiac sprue is >1% and is the dominant strategy when the prevalence
is >8%.
History and Symptoms
- Clinical 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.[6][7][8]
- The most common symptoms of IBS include abdominal pain, altered bowel habits, bloating and flatulence.[9][10]
OR
- An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
- [Test] is usually normal among patients with [disease name].
- Laboratory findings consistent with the diagnosis of [disease name] include:
- [Abnormal test 1]
- [Abnormal test 2]
- [Abnormal test 3]
- Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
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.
- ↑ Schmulson MW, Chang L (1999). "Diagnostic approach to the patient with irritable bowel syndrome". Am. J. Med. 107 (5A): 20S–26S. PMID 10588169.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Occhipinti K, Smith JW (2012). "Irritable bowel syndrome: a review and update". Clin Colon Rectal Surg. 25 (1): 46–52. doi:10.1055/s-0032-1301759. PMC 3348735. PMID 23449495.