Internal Medicine

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

872 Irritable Bowel Syndrome

Abdominal pain or discomfort

Relieved with defecation, or

Associated with a change in frequency of stool, or

Associated with a change in consistency of stool

Two or more of the following, at least on one fourth of occa-

sions or days:

Altered stool frequency

Altered stool form

Altered stool passage, or

Passage of mucus, or

Bloating or feeling of abdominal distension

Diagnostic Approach to Rule Out Organic Disease

■Basic studies:

➣Blood: CBC, chemistry panel, ESR and thyroid function tests

■Basic studies:

➣Stool for blood

➣Stool (if diarrhea predominant) for ova and parasites, fecal leuko-

cytes and qualitative fat

➣Flexible sigmoidoscopy with biopsy in patients with diarrhea or

blood in stool, or in any patient over the age of 40

differential diagnosis

■Features not compatible with IBS:

➣Pain associated with anorexia, malnutrition or weight loss

➣Pain that awakens patient from sleep or prevents sleep

➣Gastrointestinal bleeding, anemia, fever

■Differential diagnosis include:

➣Inflammatory bowel disease

➣Gastrointestinal infections

➣Lactose intolerance

➣Endocrine disorders (hypo- or hyperthyroidsm, diabetes)

➣Medication-induced diarrhea or constipation

➣Malabsorption syndromes

➣Colorectal cancer

➣Endocrine tumors

➣Microscopic colitis

management

What to Do First

■Establish a therapeutic physician-patient relationship

■Educate the patient regarding the possible pathophysiology of the

syndrome and involve the patient in treatment decisions