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The diagnosis of this condition is usually made based on the history. Thus
a history of left-sided iliac fossa pain in a 20 year old female, that is relieved
by defaecation or the passing of wind, and is exacerbated by 'stress' is likely
to be irritable bowel syndrome (IBS). Young patients with chronic symptoms suggestive
of IBS, with no sinister features and normal screening investigations e.g. FBC,
ESR, CRP, endomysial antibody, can generally be given a positive diagnosis of
IBS without the need for further extensive investigation (1). However elderly
patients or those with sinister features (e.g. weight loss, anaemia) or recent
onset will require more invasive investigation. A formal diagnostic criteria
for IBS has been developed in the form of the Rome II criteria (2): At
least 12 weeks, which need not be consecutive, in the preceeding 12 months of
abdominal discomfort or pain that has two of the three features: - relieved
by defecation, and/or
- associated with change of frequency of stool and/or
- associated with change of consistency of stool
The following
cumulatively support the diagnosis of IBS: - more than three motions
per day
- less than three motions per week
- hard or lumpy stools
- loose
or watery stools
- straining during a bowel movement
- urgency
- feeling
of incomplete emptying
- passing mucus during a bowel movement
- abdominal
fullness, bloating or swelling
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Red
flag symptoms that indicate need for colonoscopy in patients with suspected irritable
bowel syndrome (3): - age > 50 years
- weight loss
- occult
blood in faeces
- family history of colorectal cancer
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Notes: -
there are several other points to consider when making a diagnosis with respect
to recurrent abdominal pain:
- beware false correlations between radiological
findings and symptoms. Elderly patient may often have diverticular disease and/or
a hiatus hernia. These conditions are often asymptomatic and may not be the cause
of a patient's symptoms
- in female patients, possible gynaecological problems
must be excluded
- a history of recurrent left iliac fossa pain is likely
to be irritable bowel syndrome in a 30 year old patient - in an elderly patient
other diagnoses such as neoplasia must be considered
- recurrent right
hypochondrial pain may be due to irritable bowel syndrome or gall-bladder disease;
-
the presence of abdominal bruits does not mean that the patient is suffering from
ischaemic bowel disease - two different pathologies may be present in the same
patient
- NICE suggest that (4):
- healthcare professionals
should consider assessment for IBS if the person reports having had any of the
following symptoms for at least 6 months (rather than 3 months of symptoms noted
in the Rome criteria):
- abdominal pain or discomfort
- bloating
- change
in bowel habit
- a diagnosis of IBS should be considered only
if the person has abdominal pain or discomfort that is either relieved by defaecation
or associated with altered bowel frequency or stool form. This should be accompanied
by at least two of the following four symptoms:
- altered stool passage
(straining, urgency, incomplete evacuation)
- abdominal bloating (more
common in women than men), distension, tension or hardness
- symptoms made
worse by eating
- passage of mucus
- other features such
as lethargy, nausea, backache and bladder symptoms are common in people with IBS,
and may be used to support the diagnosis
Reference: -
Prescriber (2000);11 (22): 61-69.
- Thompson
W.G. et al (1999). Functional bowel disorders and functional abdominal pain. Gut
45 supplement II: II43?II47.
- Hatlebakk
J.G, Hatlebakk M.V (2004). Diagnostic approach to suspected irritable bowel syndrome.
Best Practice & Research Clinical Gastroenterology;18(4):735-746.
-
NICE (February 2008).Irritable
bowel syndrome in adults - diagnosis and management of irritable bowel syndrome
in primary care.
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