An organic cause is suggested by bloody stool, weight loss greater than 10 pounds, family history of colon cancer, recurring fever, low red blood cell count, and chronic severe diarrhea.
IBS is likely if patient has IBS symptoms with none suggestive of organic cause and normal CBC, chemistries and ESR.
Can consider additional testing in those with suggestive history:
- stool for culture if concern for infectious diarrhea
- IgA antibody if concern for celiac disease
- sigmoidoscopy if concern for inflammatory bowel disease or age > 50
Although there are multple theories, the cause of IBS is uncertain.
Multiple treatment modalities may be tried depending on the patients symptoms:
- given similarty of symptoms between lactose/fructose intolerace and IBS consider trial of lactose and fructose free diet
- in patients who complain of gas, consider limiting intake of gas producing foods (beans, onions, celery, carrots, raisons, bananas, apricots, pruns, wheat germ, pretzels, and bagels)
- in patients with constipation, consider fiber supplementation
- in patients who associate their IBS symptoms with stress, consider behavioral treatments
- although there is no great data to support their use, in patients with severe symtoms refractory to the above interventions, medications including antispasmodic agents, antidepressants, antidiarrheal agents and antibiotics can be considered
Source
Chun, Andrew MD and Wald, Arnold MD. "Clinical manifestations and diagnosis of irritable bowel syndrome." Up to date. 16 May 2008. <http://www.utpdate.com>
Wald, Arnold. "Treatment of irritable bowel syndrome." Up to date. 14 May 2008. <http://www.uptodate.com>
