Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

Irritable Bowel Syndrome 871

➣Diarrhea

Frequent loose stools of small to moderate volume with or

without mucus

Occurs during waking hours and very often after meals

Accompanied by urgency and a feeling of incomplete evacua-

tion

➣Constipation

Hard, pellet shaped stools, with straining and a feeling of

incomplete evacuation

➣Alternating diarrhea and constipation

■Other common gastrointestinal symptoms :

➣Bloating, flatulence, belching, intermittent dyspepsia, nausea,

early satiety, gastroesophageal reflux, dysphagia and non-cardiac

chest pain

■Other extra-intestinal symptoms:

➣Impaired sexual function, dysmenorrhea, dsyspareunia,

increased urinary frequency and urgency, and fibromyalgia

Physical Signs

■Physical exam usually unremarkable

■Palpable and tender sigmoid colon or discomfort on rectal exami-

nation in patients with constipation

tests

Diagnostic Criteria

■No biological disease markers to make a diagnosis

■Diagnosis based on identification of symptoms consistent with IBS,

and exclusion of organic disorders

■Two sets of diagnostic criteria have been used for definition:

➣Manning criteria: the likelihood of IBS is proportional to the

number of criteria present:

Pain relieved with defecation

More frequent stools at the onset of pain

Looser stools at the onset of pain

Visible abdominal distension

Passage of mucus

Sensation of incomplete evacuation

➣The Rome criteria developed by an international consensus

team:

At least three months of continuous or recurrent symptoms of

the following: