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

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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:
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    • [Finding 2]
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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.

.