DiagnosingBS.doc

Diagnosing Irritable Bowel Syndrome A Changing Clinical Paradigm Phillip K. Henderson, DO, Jack A. DiPalma, MD South Med J. 2011;104(3):195-199. Abstract and Introduction Abstract Rather than being a diagnosis of exclusion, irritable bowel syndrome (IBS) is a diagnosis that can be identified by symptom-based criteria. The collection of these criteria by a meticulous history can be enhanced by using various tools. Once a positive diagnosis is made, using clinical criteria for diagnosis, one should look for alarm or warning symptoms or signs, and should characterize the type of bowel habit. Determining whether the condition is a diarrhea-predominant or a constipation-predominant IBS will direct further diagnostic evaluation and management. Introduction Irritable bowel syndrome (IBS) is among the most common gastrointestinal disorders in North America, with a 15–30% prevalence.[1–3] It is a functional bowel disorder characterized by recurrent abdominal discomfort, which may be improved with defecation, and is associated with changes in stool frequency or form. The chronic nature of this condition and its severity has a notable impact on a patients quality of life and healthcare utilization.[4,5] Many IBS patients dont seek care, and when they do, a diagnosis can be challenging. In the absence of specific biological markers or pathognomonic tests, the diagnosis is based on symptoms. Oftentimes, clinicians consider a diagnosis of IBS when a diagnostic evaluation is performed and is negative. This review will discuss a positive approach to IBS which utilizes clinical criteria for diagnosis. Symptom or Syndrome IBS is one of several functional gastrointestinal disorders; there are several other functional pain disorders such as fibromyalgia, chronic pelvic pain, and interstitial cystitis.[3] The symptoms IBS patients experience are common and can be seen in normal individuals. W. Grant Thompson described symptoms as personal experiences, and syndromes as groups of symptom