IRRITABLE BOWEL SYNDROME

Summary

Irritable bowel syndrome symptoms include recurrent abdominal pain or discomfort that is
associated with a change in stool frequency or form. The pain or discomfort may be relieved
by defecation.

It is important to determine whether there are any dietary associations such as lactose-
containing foods or fructose-containing foods.

Examination of the abdomen is usually unremarkable. There may be mild and poorly
localised tenderness in the right lower quadrant and/or left lower quadrant.

The diagnosis is based on the patient's history, and there are no specific diagnostic tests. If
the patient has worrying symptoms or findings such as anaemia, weight loss, or fever, then
these require more thorough investigation.

Treatment should be individualised and is dependent on the patient's predominant symptoms.

Definition

Irritable bowel syndrome (IBS) is a chronic condition characterised by abdominal pain

associated with bowel dysfunction. The pain is often relieved by defecation and is sometimes
accompanied by abdominal bloating. There are no structural abnormalities to explain the
pain. IBS occurs in about 15% of the adult population. The aetiology is probably multi-
factorial and evidence suggests motility, inflammatory, genetic, immune, psychological, and
dietary components. [1]

History and exam

Key diagnostic factors

 presence of risk factors

 abdominal discomfort
 alteration of bowel habits associated with pain
 abdominal bloating or distension

Full details
Other diagnostic factors

 passage of mucus with stool

Risk factors

 physical and sexual abuse

 age <50 years
 female sex
 previous enteric infection

Diagnostic investigations
1st investigations to order

 FBC
 stool studies
 anti-endomysial antibodies
 anti-tTG antibodies

Investigations to consider

 hydrogen breath test

 faecal calprotectin
 serum CRP