Summary
Definition
History and exam
Key diagnostic factors
- abdominal pain
- alteration of bowel habits associated with pain
- abdominal bloating or distension
- normal exam of abdomen
Other diagnostic factors
- passage of mucus with stool
- urgency of defecation
Risk factors
- physical and sexual abuse
- posttraumatic stress disorder (PTSD)
- age <50 years
- female sex
- previous enteric infection
- family history
- family and job stress
Diagnostic tests
1st tests to order
- CBC
Tests to consider
- fecal occult blood test
- quantitative fecal immunochemical test (FIT)
- serologic tests for celiac disease
- fecal calprotectin
- fecal lactoferrin
- serum C-reactive protein (CRP)
- erythrocyte sedimentation rate (ESR)
- serum fibroblast growth factor 19
- 23‐seleno‐25‐homotaurocholic acid (SeHCAT) test
- 48-hour stool collection for total bile acids
- empiric trial of bile acid binder
- hydrogen/methane breath test
- stool tests for Giardia lamblia
- plain abdominal radiograph
- colonoscopy
- flexible sigmoidoscopy
Treatment algorithm
constipation-predominant
diarrhea-predominant
alternating constipation and diarrhea
Contributors
Authors
Ned Snyder, MD, MACP, AGAF
Professor of Medicine
Baylor College of Medicine and Marion DeBakey VA Hospital
Houston
TX
Adjunct Professor of Medicine
University of Texas Medical Branch
Galveston
TX
Disclosures
NS declares that he is a member on the board of the Kelsey Research Foundation, a non-profit organization. Kelsey Research Foundation has received and awarded private grants for the study of the microbiome in several diseases, including irritable bowel syndrome.
Peer reviewers
Douglas Drossman, MD
Professor of Medicine and Psychiatry
School of Medicine
Co-Director
UNC Center for Functional GI and Motility Disorders
Chapel Hill
NC
Disclosures
DD declares that he has no competing interests.
Simon McLaughlin, MBBS
Research Fellow
Department of Gastroenterology
St Mark's Hospital
Northwick Park
Harrow
UK
Disclosures
SM declares that he has no competing interests.
Horace Williams, MBBS
Clinical Research Fellow
Division of Medicine
Imperial College
London
UK
Disclosures
HW declares that he has no competing interests.
Differentials
- Crohn disease
- Ulcerative colitis
- Microscopic colitis
More DifferentialsGuidelines
- Probiotics and prebiotics
- AGA clinical practice update on the role of diet in irritable bowel syndrome: expert review
More GuidelinesPatient information
Irritable bowel syndrome: what is it?
Irritable bowel syndrome: what treatments work?
More Patient information- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer