Irritable Bowel Syndrome Diagnosis
From the late 1990s, research publications began identifying specific biochemical changes present in tissue biopsies and serum samples from IBS patients. These studies identified cytokines and secretory products in tissues taken from IBS patients. The cytokines identified in IBS patients produce inflammation and are associated with the body’s immune response.
There is research to support IBS being caused by an as-yet undiscovered active infection. A study found that the antibiotic Rifaximin provides sustained relief for IBS patients. Some researchers see this as evidence that IBS is related to an undiscovered agent, others believe IBS patients suffer from overgrowth of intestinal flora and the antibiotics are effective in reducing the overgrowth.
Other researchers have focused on an unrecognized protozoal infection as a cause of IBS as certain protozoal infections occur more frequently in IBS patients. Two of the protozoa investigated have a high prevalence in industrialized countries and infect the bowel, but little is known about them as they are recently emerged pathogens.
Blastocystis is a single-celled organism which has been reported to produce symptoms of abdominal pain, constipation and diarrhea in patients though these reports are contested by some physicians. Researchers have noted that clinical diagnostics fail to identify infection, and Blastocystis may not respond to treatment with common antiprotozoals.
Dientamoeba fragilis is a single-celled organism which produces abdominal pain and diarrhea. Studies have reported a high incidence of infection in developed countries, and symptoms of patients resolve following antibiotic treatment. Researchers have noted that methods used clinically may fail to detect some Dientamoeba fragilis infections. It is also found in people without IBS.
There is no specific laboratory or imaging test which can be performed to diagnose irritable bowel syndrome. Diagnosis of IBS involves excluding conditions which produce IBS-like symptoms, and then following a procedure to categorize the patient’s symptoms. In patients over 50 years old it is recommended that they undergo a screening colonoscopy.
Because there are many causes of diarrhea that give IBS-like symptoms, the American Gastroenterological Association published a set of guidelines for tests to be performed to rule out other causes for these symptoms. These include parasitic infections, gastrointestinal infections, lactose intolerance, small intestinal bacterial overgrowth and celiac disease.
Once other causes have been excluded, the diagnosis of IBS is performed using a diagnostic algorithm. Well-known algorithms include the Manning Criteria, the obsolete Rome I and II criteria, the Kruis Criteria. Physicians may choose to use one of these guidelines, or may simply choose to rely on their own anecdotal experience with past patients.
The algorithm may include additional tests to guard against mis-diagnosis of other diseases as IBS. Such “red flag” symptoms may include weight loss, GI bleeding, anemia, or nocturnal symptoms. However, researchers have noted that red flag conditions may not always contribute to accuracy in diagnosis — for instance, as many as 31% of IBS patients have blood in their stool.
Irritable bowel syndrome often disrupts daily living activities. Nineteen percent of respondents in a survey of married or cohabiting people with IBS stated they had difficulties in their personal relationships, and 45% stated that itinterfered with their sex life. The need for effective irritable bowel syndrome treatment is therefore of a high priority.
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