Irritable bowel syndrome other diagnostic studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

In young patients with symptoms of classic irritable bowel syndrome (IBS), additional invasive investigations such as endoscopy are not required and increase patient dissatisfaction. However, endoscopic evaluation is performed in difficult cases of IBS where history is unclear but the physical examination is suggestive of the diagnosis. All IBS patients with alarm features must undergo endoscopic evaluation. Moreover, colonoscopy must be considered in patients aged more than 50 years as part of routine colon cancer screening. Sigmoid colon biopsies and duodenal biopsies are required for exclusion of microscopic colitis, Crohn’s disease, and celiac disease. Anorectal manometry is a diagnostic technique used to rule out obstructive defecation (pelvic-floor dyssynergia).

Other Diagnostic Studies

Endoscopy

In young patients with symptoms of classic irrfitable bowel syndrome (IBS), additional invasive investigations such as endoscopy are not required and increase patient dissatisfaction. However, endoscopic evaluation is performed for the following indications:^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]

Gastrointestinal endoscopy is done in difficult cases of IBS where history is unclear but the physical examination is suggestive of the diagnosis.
All IBS patients with alarm features must undergo endoscopic evaluation.
Colonoscopy must be considered in patients aged more than 50 years as part of routine colon cancer screening.
In IBS patients with persistent diarrhea of age >40 years, a colonoscopy should also be performed to rule out organic causes like IBD and perform biopsies.
IBS patients with dyspepsia should undergo esophagogastroduodenoscopy.
Sigmoidoscopy is performed in patients in order to exclude melanosis coli due to laxative abuse and microinflammation.
Sigmoid colon biopsies and duodenal biopsies are required for exclusion of microscopic colitis, Crohn’s disease, and Celiac disease.

Anorectal manometry

Anorectal manometry rules out obstructive defecation (pelvic-floor dyssynergia).^[11]^[12]

References

↑ Begtrup LM, Engsbro AL, Kjeldsen J, Larsen PV, Schaffalitzky de Muckadell O, Bytzer P, Jarbøl DE (2013). “A positive diagnostic strategy is noninferior to a strategy of exclusion for patients with irritable bowel syndrome”. Clin. Gastroenterol. Hepatol. 11 (8): 956–62.e1. doi:10.1016/j.cgh.2012.12.038. PMID 23357491.
↑ Guagnozzi D, Arias Á, Lucendo AJ (2016). “Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders”. Aliment. Pharmacol. Ther. 43 (8): 851–862. doi:10.1111/apt.13573. PMID 26913568.
↑ Hilpüsch F, Johnsen PH, Goll R, Valle PC, Sørbye SW, Abelsen B (2017). “Microscopic colitis: a missed diagnosis among patients with moderate to severe irritable bowel syndrome”. Scand. J. Gastroenterol. 52 (2): 173–177. doi:10.1080/00365521.2016.1242025. PMID 27796144.
↑ Cash BD, Schoenfeld P, Chey WD (2002). “The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review”. Am. J. Gastroenterol. 97 (11): 2812–9. doi:10.1111/j.1572-0241.2002.07027.x. PMID 12425553.
↑ Suleiman S, Sonnenberg A (2001). “Cost-effectiveness of endoscopy in irritable bowel syndrome”. Arch. Intern. Med. 161 (3): 369–75. PMID 11176762.
↑ MacIntosh DG, Thompson WG, Patel DG, Barr R, Guindi M (1992). “Is rectal biopsy necessary in irritable bowel syndrome?”. Am. J. Gastroenterol. 87 (10): 1407–9. PMID 1415096.
↑ Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P (2007). “Guidelines on the irritable bowel syndrome: mechanisms and practical management”. Gut. 56 (12): 1770–98. doi:10.1136/gut.2007.119446. PMC 2095723. PMID 17488783.
↑ Chey WD, Nojkov B, Rubenstein JH, Dobhan RR, Greenson JK, Cash BD (2010). “The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial”. Am. J. Gastroenterol. 105 (4): 859–65. doi:10.1038/ajg.2010.55. PMC 2887227. PMID 20179696.
↑ Kamp EJ, Kane JS, Ford AC (2016). “Irritable Bowel Syndrome and Microscopic Colitis: A Systematic Review and Meta-analysis”. Clin. Gastroenterol. Hepatol. 14 (5): 659–68.e1, quiz e54–5. doi:10.1016/j.cgh.2015.09.031. PMID 26453949.
↑ Gudsoorkar VS, Quigley EM (2016). “Distinguishing Microscopic Colitis From Irritable Bowel Syndrome”. Clin. Gastroenterol. Hepatol. 14 (5): 669–70. doi:10.1016/j.cgh.2015.12.019. PMID 26707680.
↑ Surrenti E, Rath DM, Pemberton JH, Camilleri M (1995). “Audit of constipation in a tertiary referral gastroenterology practice”. Am. J. Gastroenterol. 90 (9): 1471–5. PMID 7661172.
↑ Treurniet-Donker AD, Helle PA, van Putten WL (1986). “Adjuvant post-operative radiotherapy in operable node positive mammary cancer: a comparison of three treatment protocols”. Int. J. Radiat. Oncol. Biol. Phys. 12 (12): 2067–72. PMID 3793542.

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[pmid23357491-1] Begtrup LM, Engsbro AL, Kjeldsen J, Larsen PV, Schaffalitzky de Muckadell O, Bytzer P, Jarbøl DE (2013). “A positive diagnostic strategy is noninferior to a strategy of exclusion for patients with irritable bowel syndrome”. Clin. Gastroenterol. Hepatol. 11 (8): 956–62.e1. doi:10.1016/j.cgh.2012.12.038. PMID 23357491.

[pmid26913568-2] Guagnozzi D, Arias Á, Lucendo AJ (2016). “Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders”. Aliment. Pharmacol. Ther. 43 (8): 851–862. doi:10.1111/apt.13573. PMID 26913568.

[pmid27796144-3] Hilpüsch F, Johnsen PH, Goll R, Valle PC, Sørbye SW, Abelsen B (2017). “Microscopic colitis: a missed diagnosis among patients with moderate to severe irritable bowel syndrome”. Scand. J. Gastroenterol. 52 (2): 173–177. doi:10.1080/00365521.2016.1242025. PMID 27796144.

[pmid12425553-4] Cash BD, Schoenfeld P, Chey WD (2002). “The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review”. Am. J. Gastroenterol. 97 (11): 2812–9. doi:10.1111/j.1572-0241.2002.07027.x. PMID 12425553.

[pmid11176762-5] Suleiman S, Sonnenberg A (2001). “Cost-effectiveness of endoscopy in irritable bowel syndrome”. Arch. Intern. Med. 161 (3): 369–75. PMID 11176762.

[pmid1415096-6] MacIntosh DG, Thompson WG, Patel DG, Barr R, Guindi M (1992). “Is rectal biopsy necessary in irritable bowel syndrome?”. Am. J. Gastroenterol. 87 (10): 1407–9. PMID 1415096.

[pmid17488783-7] Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P (2007). “Guidelines on the irritable bowel syndrome: mechanisms and practical management”. Gut. 56 (12): 1770–98. doi:10.1136/gut.2007.119446. PMC 2095723. PMID 17488783.

[pmid20179696-8] Chey WD, Nojkov B, Rubenstein JH, Dobhan RR, Greenson JK, Cash BD (2010). “The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial”. Am. J. Gastroenterol. 105 (4): 859–65. doi:10.1038/ajg.2010.55. PMC 2887227. PMID 20179696.

[pmid26453949-9] Kamp EJ, Kane JS, Ford AC (2016). “Irritable Bowel Syndrome and Microscopic Colitis: A Systematic Review and Meta-analysis”. Clin. Gastroenterol. Hepatol. 14 (5): 659–68.e1, quiz e54–5. doi:10.1016/j.cgh.2015.09.031. PMID 26453949.

[pmid26707680-10] Gudsoorkar VS, Quigley EM (2016). “Distinguishing Microscopic Colitis From Irritable Bowel Syndrome”. Clin. Gastroenterol. Hepatol. 14 (5): 669–70. doi:10.1016/j.cgh.2015.12.019. PMID 26707680.

[pmid7661172-11] Surrenti E, Rath DM, Pemberton JH, Camilleri M (1995). “Audit of constipation in a tertiary referral gastroenterology practice”. Am. J. Gastroenterol. 90 (9): 1471–5. PMID 7661172.

[pmid3793542-12] Treurniet-Donker AD, Helle PA, van Putten WL (1986). “Adjuvant post-operative radiotherapy in operable node positive mammary cancer: a comparison of three treatment protocols”. Int. J. Radiat. Oncol. Biol. Phys. 12 (12): 2067–72. PMID 3793542.

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