Irritable Bowel Syndrome

ANMS Irritable Bowel Syndrome

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Diagnosis and Assessment Table 1. Rome III Criteria for IBS Recurrent abdominal pain or discomforta associated with 2 or more of the following: at least 3 days per month in the last 3 monthsb • Improvement with defecation • Onset associated with a change in frequency of stool • Onset associated with a change in form (appearance) of stool a Discomfort means an uncomfortable sensation not described as pain. b Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis. Figure 1. Bristol Stool Form Scale Type 1 Type 2 Type 3 Type 4 Type 5 Type 6 Type 7 Separate hard lumps, like nuts (hard to pass) Sausage-shaped, but lumpy Like a sausage but with cracks on its surface Like an Italian sausage or snake, smooth and soſt Soſt blobs with clear cut edges (passed easily) Fluffy pieces with ragged edges, a mushy stool Watery, no solid pieces. Entirely liquid Copyright Rome Foundation, Bristol Stool Form Scale developed by Dr Ken Heaton, University of Bristol, UK. ÎSerological screening for celiac sprue (ie, tTG antibody) is recommended in patients with IBS-D and mixed pattern IBS (IBS-M) (1B). ÎPerform colonoscopy in IBS patients with alarm features to rule out organic diseases and in those > 50 years for the purpose of colorectal cancer screening (1C). ÎConsider lactose breath testing when lactose maldigestion remains a concern despite dietary modification (2B). ÎCurrently, there are insufficient data to recommend breath testing for small intestinal bacterial overgrowth (SIBO) in IBS patients (2C). ÎBecause of the low pretest probability of Crohn's disease, ulcerative colitis, and colonic neoplasia, routine colonic imaging is NOT recommended in patients < 50 years of age with typical IBS symptoms and no alarm features (1B). ÎConsider obtaining random biopsies to rule out microscopic colitis during colonoscopy in patients with IBS-D (2C). ÎRoutine diagnostic testing with complete blood count, serum chemistries, thyroid function studies, stool for ova and parasites, and abdominal imaging is NOT recommended in patients with typical IBS symptoms and no alarm features because of a low likelihood of uncovering organic disease (1C).

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