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Diagnostic Approach

Since many disorders present with symptoms similar to irritable bowel syndrome (IBS), it is important to exclude other causes. Patients are identified as having a symptom complex compatible with IBS based upon the Rome III criteria (table 1). Routine laboratory studies (complete blood count, chemistries) are normal in IBS.  In patients who have symptoms suggestive of IBS, no alarm symptoms and no family history of inflammatory bowel disease or colorectal cancer, a limited number of diagnostic studies can rule out organic illness in the majority of patients9. The diagnostic evaluation depends upon whether the predominant symptom is diarrhea or constipation:

Diarrhea predominant IBS1

In patients with diarrhea as the predominant symptom the following screening tests are suggested:

  • Stool cultures
  • Celiac disease screening
  • Twenty-four hour stool collection
  • Colonoscopy or flexible sigmoidoscopy and biopsy

Constipation predominant IBS1

In patients with constipation as the predominant symptom, the following tests might be suggested:

  • Radiography
  • Flexible sigmoidoscopy and colonoscopy
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