Irritable bowel syndrome history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
History and symptoms
The symptoms of IBS are abdominal pain in association with frequent diarrhea, constipation, or a change in bowel habits.[1]
The underlying biochemical causes of IBS are not well established. As such, there is no specific laboratory test which can be performed to diagnose this condition.[2] Diagnosis of IBS involves excluding conditions that produce with IBS-like symptoms and then following a procedure to categorize the patient's symptoms.
Because there are many causes of diarrhea and IBS-like symptoms, the American Gastroenterological Association has published a set of guidelines for tests to be performed to diagnose other conditions that may have symptoms similar to IBS. These include gastrointestinal infections, lactose intolerance and coeliac disease. Research has suggested that these guidelines are not always followed.[2] Once other causes have been excluded, the diagnosis of IBS is performed using a diagnostic algorithm. Well-known algorithms include the Manning Criteria, the Rome I Criteria, the Rome II Process, the Kruis Criteria, and studies have compared their reliability.[3] The more recent Rome III Process was published in 2006. Physicians may choose to use one of these criteria, or may use other guidelines based on their own experience and the patient's history. The algorithm may include additional tests to guard against misdiagnosis of other diseases as IBS. Such "red flag" symptoms may include weight loss, GI bleeding, anemia, or nocturnal symptoms. However, researchers have noted that red flag conditions may not always contribute to accuracy in diagnosis — for instance, as many as 31% of IBS patients have blood in their stool.[3]
The diagnostic algorithm identifies a name that can be applied to the patient's condition based on the combination of the patient's symptoms of diarrhea, abdominal pain, and constipation. For example, the statement "50% of returning travelers had developed functional diarrhea, while 25% had developed IBS" would mean that half the travelers had diarrhea while a quarter had diarrhea with abdominal pain. While some researchers believe this categorization system will help physicians understand IBS, others have questioned the value of the system and suggested that all IBS patients have the same underlying disease but with different symptoms.[4]
Diagnostic Criteria
The diagnostic criteria based on the American Gastroenterological Association (AGA),[5] Rome III criteria[6] and pharmacologic studies based criteria[7] is as follows.
| Rome III criteria[5][6] | Pharmacologic studies based criteria[5][7] |
|---|---|
| Abdominal pain or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following: ● Improves with defecation |
Spontaneous bowel movements 3 per week and 1 of the following symptoms for at least 12 weeks during the past 12 months: ● Straining in one-fourth or more of defecation |
Misdiagnosis
Published research has demonstrated that some poor patient outcomes are due to treatable causes of diarrhea being misdiagnosed as IBS. Common examples include infectious diseases, celiac disease,[8] parasites,[9] food allergies[10] (though considered controversial), and lactose intolerance.[11] See the list of causes of diarrhea for other conditions which can cause diarrhea.
Coeliac disease in particular is often misdiagnosed as IBS:
Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases. In fact, sometimes celiac disease is confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, Crohn’s disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease is commonly underdiagnosed or misdiagnosed.[12]
Medical conditions that accompany IBS
Researchers have identified several medical conditions, or comorbidities, which appear with greater frequency in patients diagnosed with IBS.
Headache, Fibromyalgia, and Depression
A study of 97,593 individuals with IBS identified comorbidities as headache, fibromyalgia and depression.[13] Fibromyalgia has also been identified in other studies as a comorbidity of IBS.[14][15]
Inflammatory Bowel Disease
Some researchers have suggested that IBS is a type of low-grade inflammatory bowel disease.[16] Researchers have suggested that IBS and IBD are interrelated diseases,[17] noting that patients with IBD experience IBS-like symptoms when their IBD is in remission.[18][19] A 3-year study found that patients diagnosed with IBS were 16.3 times more likely to develop IBD during the study period.[20] Serum markers associated with inflammation have also been found in patients with IBS (see Causes).
Abdominal Surgery
A 2005 study published in Digestive Disease Science reported that IBS patients are 87% more likely to undergo abdominal and pelvic surgery, and three times more likely to undergo gallbladder surgery.[21] A study published in Gastroenterology came to similar conclusions, and also noted IBS patients were twice as likely to undergo hysterectomy.[22]
Endometriosis
One study has reported a statistically significant link between migraine headaches, IBS, and endometriosis.[23]
References
- ↑ Schmulson MW, Chang L (1999). "Diagnostic approach to the patient with irritable bowel syndrome". Am. J. Med. 107 (5A): 20S–26S. PMID 10588169.
- ↑ 2.0 2.1 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.
- ↑ 3.0 3.1 Fass R, Longstreth GF, Pimentel M; et al. (2001). "Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome". Arch. Intern. Med. 161 (17): 2081–8. PMID 11570936.
- ↑ 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.
- ↑ 5.0 5.1 5.2 Bharucha AE, Pemberton JH, Locke GR (2013). "American Gastroenterological Association technical review on constipation". Gastroenterology. 144 (1): 218–38. doi:10.1053/j.gastro.2012.10.028. PMC 3531555. PMID 23261065.
- ↑ 6.0 6.1 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. Unknown parameter
|month=ignored (help) - ↑ 7.0 7.1 Johnston, JM.; Kurtz, CB.; Macdougall, JE.; Lavins, BJ.; Currie, MG.; Fitch, DA.; O'Dea, C.; Baird, M.; Lembo, AJ. (2010). "Linaclotide improves abdominal pain and bowel habits in a phase IIb study of patients with irritable bowel syndrome with constipation". Gastroenterology. 139 (6): 1877–1886.e2. doi:10.1053/j.gastro.2010.08.041. PMID 20801122. Unknown parameter
|month=ignored (help) - ↑ Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS (2004). "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. PMID 15188167.
- ↑ Stark D, van Hal S, Marriott D, Ellis J, Harkness J. (2007). "Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis". Int J Parasitol. 31 (1): 11–20. PMID 17070814.
- ↑ Drisko; et al. (2006). "Treating Irritable Bowel Syndrome with a Food Elimination Diet Followed by Food Challenge and Probiotics". Journal of the American College of Nutrition. 25 (6): 514–22. PMID 17229899.
- ↑ Vernia P, Ricciardi MR, Frandina C, Bilotta T, Frieri G (1995). "Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet". The Italian journal of gastroenterology. 27 (3): 117–21. PMID 7548919.
- ↑ http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/ - The United States National Institutes of Health Celiac Disease Page
- ↑ Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA (2006). "Migraine,fibromyalgia, and depression among people with IBS: a prevalence study". BMC gastroenterology. 6: 26. doi:10.1186/1471-230X-6-26. PMID 17007634.
- ↑ Kurland JE, Coyle WJ, Winkler A, Zable E (2006). "Prevalence of irritable bowel syndrome and depression in fibromyalgia". Dig. Dis. Sci. 51 (3): 454–60. doi:10.1007/s10620-006-3154-7. PMID 16614951.
- ↑ Frissora CL, Koch KL (2005). "Symptom overlap and comorbidity of irritable bowel syndrome with other conditions". Current gastroenterology reports. 7 (4): 264–71. PMID 16042909.
- ↑ Bercik P, Verdu EF, Collins SM (2005). "Is irritable bowel syndrome a low-grade inflammatory bowel disease?". Gastroenterol. Clin. North Am. 34 (2): 235–45, vi–vii. doi:10.1016/j.gtc.2005.02.007. PMID 15862932.
- ↑ Quigley EM (2005). "Irritable bowel syndrome and inflammatory bowel disease: interrelated diseases?". Chinese journal of digestive diseases. 6 (3): 122–32. doi:10.1111/j.1443-9573.2005.00202.x. PMID 16045602.
- ↑ Simrén M, Axelsson J, Gillberg R, Abrahamsson H, Svedlund J, Björnsson ES (2002). "Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors". Am. J. Gastroenterol. 97 (2): 389–96. PMID 11866278.
- ↑ Minderhoud IM, Oldenburg B, Wismeijer JA, van Berge Henegouwen GP, Smout AJ (2004). "IBS-like symptoms in patients with inflammatory bowel disease in remission; relationships with quality of life and coping behavior". Dig. Dis. Sci. 49 (3): 469–74. PMID 15139501.
- ↑ García Rodríguez LA, Ruigómez A, Wallander MA, Johansson S, Olbe L (2000). "Detection of colorectal tumor and inflammatory bowel disease during follow-up of patients with initial diagnosis of irritable bowel syndrome". Scand. J. Gastroenterol. 35 (3): 306–11. PMID 10766326.
- ↑ Cole JA, Yeaw JM, Cutone JA; et al. (2005). "The incidence of abdominal and pelvic surgery among patients with irritable bowel syndrome". Dig. Dis. Sci. 50 (12): 2268–75. doi:10.1007/s10620-005-3047-1. PMID 16416174.
- ↑ Longstreth GF, Yao JF (2004). "Irritable bowel syndrome and surgery: a multivariable analysis". Gastroenterology. 126 (7): 1665–73. PMID 15188159.
- ↑ Tietjen GE, Bushnell CD, Herial NA, Utley C, White L, Hafeez F (2007). "Endometriosis is associated with prevalence of comorbid conditions in migraine". Headache. 47 (7): 1069–78. doi:10.1111/j.1526-4610.2007.00784.x. PMID 17635599.