Irritable Bowel Syndrome (IBS) - Diagnosis and Workup Summary
Use a positive diagnostic strategy with minimal testing. IBS is NOT a diagnosis of exclusion.
Rome IV Criteria - Recurrent abdominal pain ~ ≥ 1x/ week in last 3 months + symptom onset ≥ 6 months associated with ≥ 2 of the following:
1. Related to defecation
2. Change in frequency of stool
3. Change in form of stool
* Bloating not required for diagnosis
No Need For:
• Routine stool cultures, but test for Giardia in those at high risk
• Routine colonoscopy in <45 yo w/o red flags - Low chance of "missing things" → fewer polyps in IBS vs non-IBS!
• Food allergy/ sensitivity testing unless reproducible reactions
Don't Forget to Rule Out These Things!
• If Diarrhea:
- Rule out celiac disease w/ T TG IgA & IgA or 6 biopsies from duodenum (including bulb)
- Rule out inflammatory bowel disease w/ fecal calprotectin or fecal lactoferrin + CRP
• If ?Pelvic Floor Disorder &/or Refractory Constipation - Diagnose dyssynergic defecation w/ 2 of 3:
- Anorectal manometry (ARM)
- Balloon Expulsion Test (BET)
- Defecography
by Tina Hang, MD @TinaPhamHang via Emory Gastroenterology and Hepatology @EmoryGastroHep
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