Summary
Definition
History and exam
Key diagnostic factors
- abdominal discomfort
- alteration of bowel habits associated with pain
- abdominal bloating or distention
- normal exam of abdomen
Other diagnostic factors
- passage of mucus with stool
- urgency of defecation
Risk factors
- physical and sexual abuse
- PTSD
- age <50 years
- female sex
- previous enteric infection
- family history
- family and job stress
Diagnostic investigations
1st investigations to order
- CBC
Investigations to consider
- fecal occult blood test
- 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
Chief of Gastroenterology and Hepatology
Kelsey-Seybold Clinic
Clinical Professor of Medicine
Baylor College of Medicine
Houston
Adjunct Professor of Medicine
University of Texas Medical Branch
Galveston
TX
Disclosures
NS declares that he is on the board of the Kelsey Research Foundation, a non-profit organization that sponsors research in the intestinal microbiome; he does not receive direct or indirect compensation. NS received a grant from the State of Texas to study genetic factors in the development of hepatocellular cancer in Hispanic people.
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
- Lymphocytic and collagenous colitis (microscopic colitis)
More DifferentialsGuidelines
- American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
- ACG clinical guideline: management of irritable bowel syndrome
More GuidelinesPatient leaflets
Irritable bowel syndrome: what is it?
Irritable bowel syndrome: what treatments work?
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer