irritable%20bowel%20syndrome
IRRITABLE BOWEL SYNDROME
Irritable bowel syndrome is a common chronic gastrointestinal condition characterized by abdominal pain and bloating with altered bowel habits.
There are no identifiable physical, radiologic or lab abnormalities indicative of organic disease.
Symptoms may be exacerbated by stress, alcohol or food.

Definition

  • A chronic, relapsing functional bowel disorder characterized by abdominal pain and bloating with altered bowel habits that may affect the patient's quality of life

Signs and Symptoms

  • Symptoms may be exacerbated by stress, alcohol, food, abdominal and/or pelvic surgery, a sequela of gastrointestinal infection, and/or a difficult life changing event in the patient's life
Recurrent Abdominal Pain
  • Pain is intermittent 
  • Patient may describe pain as crampy in nature with variable intensity and periodic exacerbations
  • Location and character of pain may vary
  • Defecation or passing of flatus often provides relief
Altered Bowel Habits
  • Diarrhea, constipation, alternating diarrhea and constipation or normal bowel habits alternating with either diarrhea and/or constipation
Other GI Symptoms
  • Gastroesophageal reflux, dysphagia, early satiety, intermittent dyspepsia, nausea, noncardiac chest pain
Extraintestinal Symptoms
  • Urinary frequency and urgency, sexual dysfunction, fibromyalgia, dyspareunia, poor sleep, menstrual difficulties, lower back pain, headaches, chronic fatigue and insomnia
  • The more extracolonic symptoms, the greater likelihood of having severe IBS

Alarm Symptoms

  • Age ≥50 years old
  • Short duration of symptoms
  • Nocturnal symptoms
  • Hematochezia, occult blood in the stool
  • Unintended weight loss 
  • Family history of colon cancer, ovarian cancer, inflammatory bowel disease (IBD), celiac sprue, recurring fever
  • Iron-deficiency anemia
  • Recent medication use (antibiotics)
  • Abdominal or rectal mass
  • Ascites
  • Inflammatory markers for IBD
  • More loose or more frequent stools or both, persisting for >6 weeks in an individual >60 years old

Other Signs or Symptoms

Other signs or symptoms that may lead the clinician to perform routine diagnostic tests:
  • History of travel to locations with endemic parasitic diseases
  • Family history of IBD
  • Relation to menstruation, consumption of unknown foods that cause intolerance (especially milk), artificial sweeteners, dieting products, or alcohol 
  • Arthritis or skin findings on physical exam
  • Signs or symptoms of malabsorption
  • Signs or symptoms of thyroid dysfunction
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