Irritable bowel syndrome other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
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OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
- There are no other diagnostic studies associated with [disease name].
- [Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include:
- [Finding 1]
- [Finding 2]
- [Finding 3]
- Other diagnostic studies for [disease name] include:
- [Diagnostic study 1], which demonstrates:
- [Finding 1]
- [Finding 2]
- [Finding 3]
- [Diagnostic study 2], which demonstrates:
- [Finding 1]
- [Finding 2]
- [Finding 3]
- [Diagnostic study 1], which demonstrates:
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, a colonoscopy should also be performed.
Most patients should have a sigmoidoscopic examination; in additionIn 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, a colonoscopy should also be performed.
In patients with concurrent symptoms of dyspepsia,
esophagogastroduodenoscopy may be
advisable.
In patients with alarm features, we perform additional evaluation to exclude other causes of similar symptoms [46].
The diagnostic evaluation usually includes endoscopic evaluation in all patients and imaging in selected cases.
In patients with diarrhea, we perform colonoscopy to evaluate for the presence of IBD and perform biopsies to exclude microscopic colitis [47-49].
Endoscopy
Specialist investigations such as gastrointestinal endoscopy
or radiological evaluation should be reserved for
difficult cases where the diagnosis may not be clear from
the history, and/or physical examination suggest pathology.
Sigmoidoscopy should be done in all patients to exclude
inflammation and melanosis coli (laxative abuse),
though in one series these disorders were always absent
when the Rome criteria were met.30
The difficult clinical decision is when to proceed to
colonoscopy or barium enema. This decision should be
made by a specialist, and depends mainly on the
individual patient’s risk. Risk is influenced by age (young
patients are very unlikely to have malignant pathology),
family history, duration of symptoms (IBS symptoms are
long-lived), and the presence of any sinister symptoms
(eg, rectal bleeding, weight loss, anorexia).
Colonoscopy is considered in patients aged more than 50
years as part of routine colon cancer screening and in patients
with alarm features.68
Melanosis coli indicating
laxative use and microinflammatory disease can be identified
during colonoscopy. Endoscopy is unnecessary in
young patients with classic irritable bowel syndrome
symptoms.69
Endoscopy is an expensive and limited resource, thus
we should probably reserve use of it for patients with
persistent diarrhoeal symptoms in whom duodenal and
colonoscopic biopsy specimens might be needed to
exclude coeliac disease and microscopic colitis,
respectively. However, the diagnostic yield of colonic
biopsy is very low.109,113 A high proportion of patients do
improve during follow-up, so a staged approach, though
lengthy, could save resources and avoid unnecessary
procedures.
coeliac disease.110
crohns, diagnosis of this disorder generally
cannot be made without radiological analysis of the
small bowel,
flexible sigmoidoscopy with biopsies.
Diagnosis
obstructive defecation (pelvic-floor dyssynergia) should be considered,
anorectal manometry can confirm the diagnosis.
.