Aidan: /* Differential Diagnosis */

2021-06-03T13:12:34Z

Differential Diagnosis

← Older revision		Revision as of 13:12, 3 June 2021
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	== ~~Definition~~ ==		== Background ==

	* Syndrome characterized by abdominal pain or discomfort and altered bowel movements		* Syndrome characterized by abdominal pain or discomfort and altered bowel movements
	* May be diarrhea- or constipation-predominant, or mixed		* May be diarrhea- or constipation-predominant, or mixed

	== Etiology ==		=== Etiology ===

	* Post-infectious IBS		* [[Post-infectious IBS]]
			* Idiopathic
	* Idiopathy

	== Epidemiology ==		=== Epidemiology ===

	* Prevalence of 10-15% in North America		* Prevalence of 10-15% in North America
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	== Differential Diagnosis ==		== Differential Diagnosis ==

	* Celiac disease		* [[Celiac disease]]
	* Inflammatory bowel disease (IBD)		* [[Inflammatory bowel disease]] (IBD)
	* Microscopic colitis, especially in older patients		* [[Microscopic colitis]], especially in older patients
	* Overflow diarrhea, especially in older patients		* [[Overflow diarrhea]], especially in older patients
	* Others		* Others
	** Chronic infection (e.g. Giardia, Entamboeba)		** Chronic infection (e.g. [[Giardia]], [[Entamboeba]])

⚫	== Rome Diagnostic Criteria ==

⚫	* Recurrent abdominal pain for >= 3 days per month for >= 3 months
⚫	* Two of the following:
⚫	** Symptoms improve with bowel movements
⚫	** Associated with a change in stool frequency
⚫	** Associated with a change in stool consistency

	== Investigations ==		== Investigations ==
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	* Other		* Other
	** Colonoscopy, if over 50 years old or alarm features, to rule out microscopic colitis and IBD		** Colonoscopy, if over 50 years old or alarm features, to rule out microscopic colitis and IBD

			== Diagnosis ==

			* Made based on Rome Diagnostic Criteria and the exclusion of other causes of their symptoms

		⚫	=== Rome Diagnostic Criteria ===
		⚫	* Recurrent abdominal pain for >= 3 days per month for >= 3 months
		⚫	* Two of the following:
		⚫	** Symptoms improve with bowel movements
		⚫	** Associated with a change in stool frequency
		⚫	** Associated with a change in stool consistency

	== Management ==		== Management ==

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2020-07-04T01:17:42Z

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== Definition ==

* Syndrome characterized by abdominal pain or discomfort and altered bowel movements
* May be diarrhea- or constipation-predominant, or mixed

== Etiology ==

* Post-infectious IBS
* Idiopathy

== Epidemiology ==

* Prevalence of 10-15% in North America

== Differential Diagnosis ==

* Celiac disease
* Inflammatory bowel disease (IBD)
* Microscopic colitis, especially in older patients
* Overflow diarrhea, especially in older patients
* Others
** Chronic infection (e.g. Giardia, Entamboeba)

== Rome Diagnostic Criteria ==

* Recurrent abdominal pain for >= 3 days per month for >= 3 months
* Two of the following:
** Symptoms improve with bowel movements
** Associated with a change in stool frequency
** Associated with a change in stool consistency

== Investigations ==

* Labs
** Celiac disease
*** Anti-TTG +/- IgA levels
*** HLA DQ2/DQ8, when already on gluten-free diet
** IBD
*** ESR/CRP
*** Fecal calprotectin
* Imaging
** AXR, to rule out overflow diarrhea
* Other
** Colonoscopy, if over 50 years old or alarm features, to rule out microscopic colitis and IBD

== Management ==

* Provide reassurance and education
* Lifestyle modification
** Small, frequent meals
** Avoid fatty foods
** Increased physical activity
** May try:
*** Lactose avoidance
*** Gluten- or FODMAPS-free diet
*** Dietary fibre may help or harm
** If bloating: avoid beans/dried fruit/bananas
* Medical therapy
** Mild IBS
*** Antispasmodics (butylscopolamine (Buscopan), scheduled or prn)
*** Anti-diarrheals (Immodium prn) for diarrhea-predominant
*** Probiotics (Align and Tuzen)
** Moderate or severe IBS
*** Tricyclic antidepressants (6-8 weeks to take effect)
*** SSRIs if concurrent depression
*** CBT and hypnotherapy
*** Rifaximin
*** Linaclutide (Constella) for consipation-predominant

[[Category:Gastroenterology]]

Irritable bowel syndrome - Revision history

Aidan: /* Differential Diagnosis */

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