Irritable bowel syndrome differential diagnosis

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

Content

Overview

Differentiating Irritable Bowel Syndrome from other Diseases

Differential diagnosis based on the predominant symptom(s)

References

Overview

Irritable bowel syndrome must be differentiated from other diseases that cause diarrhea, constipation, and abdominal pain, such as Celiac disease, Inflammatory bowel disease(Crohn's disease and Ulcerative colitis) Thyroid disease (Hyper or Hypothyroidism), strictures due to ischemia, diverticulitis or ischemia, among others.

The differential diagnosis for Irritable bowel syndrome can be listed based on predominant symptoms, such as constipation predominant, diarrhea predominant and pain predominant diseases.

Differentiating Irritable Bowel Syndrome from other Diseases

Diseases with similar symptoms

Differential diagnosis based on predominant symptom(s)

Differential diagnosis based on abdominal pain

The differential diagnosis of IBS based on abdominal pain is as follows:

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin

Classification of pain in the abdomen based on etiology Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Fever Rigors and chills Abdominal Pain Jaundice Diarrhea Melena/ hematochezia/ hemtemesis Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Abdominal causes Inflammatory causes Pancreato-biliary disorders Acute suppurative cholangitis + + RUQ + − − + + + N
  • Abnormal LFT
  • WBC >10,000
 Ultrasound shows biliary dilatation/stents/tumor Septic shock occurs with features of SIRS
Acute cholangitis + − RUQ + − − − − − N Ultrasound shows biliary dilatation/stents/tumor Biliary drainage (ERCP) + IV antibiotics
Acute cholecystitis + − RUQ + − − − − − Hypoactive Ultrasound shows gallstone and evidence of inflammation Murphy’s sign
Acute pancreatitis + − Epigastric ± − − ± − − N Ultrasound shows evidence of inflammation Pain radiation to back
Primary biliary cirrhosis − − RUQ/Epigastric + − − − − − N
  • Increased AMA level, abnormal LFTs
Primary sclerosing cholangitis + − RUQ + − − − − − N ERCP and MRCP shows
  • Multiple segmental strictures
  • Mural irregularities
  • Biliary dilatation and diverticula
  • Distortion of biliary tree
 The risk of cholangiocarcinoma in patients with primary sclerosing cholangitis is 400 times higher than the risk in the general population.
Cholelithiasis ± − RUQ/Epigastric ± − − − + + N to hyperactive for dislodged stone Ultrasound shows gallstone Murphy’s sign
Gastric causes Peptic ulcer disease ± − Diffuse − − + in perforated + + N
  • Ascitic fluid
    • LDH > serum LDH
    • Glucose < 50mg/dl
    • Total protein > 1g/dl
 Air under diaphragm in upright CXR Upper GI endoscopy for diagnosis
Gastritis ± − Epigastric − + in chronic gastritis −
Gastroesophageal reflux disease − − Epigastric − − − − − −
Gastric outlet obstruction − − Epigastric − − − ± Hyperactive
Gastrointestinal perforation + ± Diffuse ± − +, depends on site + + ±
  • WBC> 10,000
 Air under diaphragm in upright CXR
Dumping syndrome − − Lower and then diffuse
Intestinal causes Acute appendicitis + +in pyogenic appendicitis Starts in epigastrium, migrates to RLQ − − − + in perforated appendicitis + + Hypoactive Ultrasound shows evidence of inflammation Nausea & vomiting, decreased appetite
Acute diverticulitis + ± LLQ − − Hematochezia − + − Hypoactive CT scan and ultrasound shows evidence of inflammation
Inflammatory bowel disease ± − Diffuse ± Hematochezia
Irritable bowel syndrome ± − Diffuse − + − − − − N Tests done to exclude other diseases as it diagnosis of exclusion Tests done to exclude other diseases as it diagnosis of exclusion Symptomatic treatment
Whipple's disease ± − Diffuse ± − − ± − − N *Endoscopy is used to confirm diagnosis.

Images used to find complications

Extra intestinal findings:
Toxic megacolon + − Diffuse − + − + ± − Hypoactive CT scan shows:

Ultrasound shows:

  • Loss of haustra coli of the colon
  • Hypoechoic and thickened bowel walls with irregular internal margins in the sigmoid and descending colon
  • Prominent dilation of the transverse colon (>6 cm)
  • Insignificant dilation of ileal bowel loops (diameter >18 mm) with increased intraluminal gas and fluid
Tropical sprue + − Diffuse + −
Celiac disease − − Diffuse ±, also dermatitis herpetiformis + − − − − Hyperactive (increased sounds)
Infective colitis +
Hepatic causes Viral hepatitis + − RUQ + − − − +
Liver masses + + in Liver abscess RUQ ± − − + in sepsis
Budd-Chiari syndrome ± − RUQ ± − + in liver failure leading to varices − − − N
Findings on CT scan suggestive of Budd-Chiari syndrome include:
Ascitic fluid examination shows:
Hemochromatosis − − RUQ Dull / aching + with infections and GI involvement − + in cirrhotic patients may be in cardicmyopathy − −
  • >60% TS
  • >240 μg/L SF
  • Raised LFT
    Hyperglycemia
 Ultrasound shows evidence of cirrhosis Extra intestinal findings:
  • hyperpigmentation
  • Diabetes mellitus
  • Arthralgia
  • Impotence in males
  • Cardiomyopathy
  • Atherosclerosis
  • Hypopituitarism
  • Hypothyroidism
  • Extrahepatic cancer
  • Prone to specific infections
Cirrhosis + − RUQ + − varices −
Peritoneal causes Spontaneous bacterial peritonitis + − Diffuse + in cirrhotic patients − − ± − − Hypoactive
  • Ascitic fluid PMN>250 cells/mm³
  • Culture: Positive for single organism
 Ultrasound for evaluation of liver cirrhosis
Hollow Viscous Obstruction Small intestine obstruction − − Diffuse − − − − + ± Hyperactive then absent Leukocytosis Abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Volvulus − − Diffuse − − − − + − Hypoactive Leukocytosis CT scan and abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Biliary colic − − RUQ + − − − − − N Increased bilirubin and alkaline phosphatase Ultrasound Nausea & vomiting
Renal colic − − Flank pain − − − − − − N Hematuria CT scan and ultrasound Colicky abdominal pain associated with nausea & vomiting
Vascular Disorders Ischemic causes Mesenteric ischemia ± − Periumbilical − + Hematochezia ± − − Hyperactive Leukocytosis and lactic acidosis CT scan Nausea & vomiting, normal physical examination
Acute ischemic colitis ± ± Diffuse − + Massive + + Hyperactive then absent Leukocytosis CT scan Nausea & vomiting
Hemorrhagic causes Ruptured abdominal aortic aneurysm − − Diffuse − − Massive + − − N Normal CT scan Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage − − Diffuse − − Massive + − − N Anemia CT scan History of trauma
Gynaecological Causes Tubal causes Torsion of the cyst − − RLQ / LLQ − − − ± ± N Increased ESR and CRP Ultrasound Sudden onset sever pain with nausea and vomiting
Acute salpingitis + ± RLQ / LLQ − − − − ± ± N Leukocytosis Pelvic ultrasound Vaginal discharge
Cyst rupture − − RLQ / LLQ − − − + ± ± N Increased ESR and CRP Ultrasound Sudden onset sever pain with nausea and vomiting
Pregnancy Ruptured ectopic pregnancy − − RLQ / LLQ − − − + − − N Positive pregnancy test Ultrasound History of missed period and vaginal bleeding
Extra-abdominal causes Pulmonary disorders Pleural empyema + ± RUQ/Epigastric − − − − − − N
Cardiovascular disorders Myocardial Infarction − − Epigastric − − − + in cardiogenic shock − − N

Differential diagnosis based on constipation

The differential diagnosis of irritable bowel syndrome based on constipation as the predominant symptom is as follows:[1][2][3][4][5][6][7][8][9][10]

Differential Diagnosis for Constipation predominant symptoms Clinical features Diagnosis
Strictures due to diverticultis,inflammatory bowel disease, ischemia or cancer
Hypothyroidism
Medication
  • Medication history.
Neurologic disease
Pelvic floor dysfunction
  • Straining, self digitation
Colonic inertia


Differential Diagnosis based on abdominal pain and diarrhea

Below is a table that overviews the differential based on type of diarrhea. A more detailed table follows.

Diarrhea with abdominal pain/cramping may be caused by infectious diseases, celiac disease,[11] parasites,[12] food allergies[13] and lactose intolerance.[14] See the list of causes of diarrhea for other conditions which can cause diarrhea. Celiac disease in particular is most often misdiagnosed as IBS.[15] The differential diagnosis of irritable bowel syndrome based on abdominal pain and diarrhea is as follows:[16][17][18][19][20][21][22][23][24][25]

Overview based on type of diarrhea

Cause Osmotic gap History Physical exam Gold standard Treatment
< 50 mOsm per kg > 50 mOsm per kg*
Watery Secretory Crohns + -
Zollinger-Ellison syndrome + -
  • Gastrin levels
  • Proton pump inhibitors
  • Octreotide
Hyperthyroidism + -
VIPoma + -
  • Elevated VIPlevels
  • Followed by imaging
Osmotic Lactose intolerance - +
Celiac disease - +
Functional Irritable bowel syndrome - - Abdominal pain or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:
  • Onset associated with change in frequency of stool
 Clinical diagnosis
  • ROME IV criteria
  • Exclusion of organic causes based on laboratory investigations and imaging


Details based on pathology

Irritable bowel syndrome must be diifferentiated from other causes of abdominal pain and diarrhea.

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Abdominal pain Diarrhea Flushing Dyspnea Palpitations Other symptoms Wheezing Telangiectasia Hypotension Tachycardia Systolic murmur of tricuspid regurgitation Other physical findings Urinary 5-hydroxyindoleacetic acid (5-HIAA) Serum Chromogranin A (CgA) Other markers Abdominal computed tomography (CT) Abdominal MRI Somatostatin receptor scintigraphy [SRS], or Octreoscan Metaiodobenzylguanidine (MIBG) scintigraphy Other diagnostic studies Transthoracic echocardiography
Carcinoid Syndrome[26][27][28][29][30][31][32][33][34] Neuroendocrine tumor of midgut [35][36][37][38] +

Mild

+ + + +

Dermatitis

Diarrhea

Dementia

Metastatic tumors in the liver: Right upper quadrant pain, hepatomegaly, and early satiety

+ +/- +/- + + - + + + +
  • Valve thickening with retraction and reduction in the mobility of the tricuspid valve

Pathognomonic radiological sign of midgut NET.

Neuroendocrine tumor of lung[39][40][41][42] + + + + +
+ +/- +/- + + - + + Sensitive for detection of liver metastases if present + + - Typical low-grade:bland cells containing regular round nuclei with finely dispersed chromatin and inconspicuous small nucleoli.Mitotic figures are scarce and necrosis is absent.

Intermediate-grade atypical: presence of Neuroendocrine morphology and either necrosis or 2 to 10 mitoses per 10 HPF

Irritable Bowel Syndrome[43][44][45][46] +

Perioidic

- - - - - - - - - - - - - - - - Rome IV criteria
  • Recurrent abdominal pain, at least 1day/week in the last 3 months, a/s with 2 or more of the following criteria:

•Related to defecation

•Associated with a change in stool frequency

•Associated with a change in stool form (appearance)

Malignant neoplasms of small intestine[47][48][49] +/- +/- - - +/- - - +/- - * Abdominal mass - + Abdominal CT scan may be diagnostic of small intestine cancer. Findings on CT scan suggestive of small intestine cancer include intrinsic mass with a short segment of bowel wall thickening MRI and MRI enteroscopy are other advance modalities to diagnose and stage small intestinal cancers - - Enteroscopy, capsule endoscopy and double balloon enteroscopy Biopsy and histopathology
Crohn disease[50][51][52][53] +/- - - - - - - - - - - - - -
  • Focal ulcerations and acute and chronic inflammation
Benign cutaneous flushing[54] - - + - - - - - - - - - - - - - - - - - - -
Systemic mastocytosis[55][56][57][58][59] + + + + - +/- +/- + - - - - - -
Asthma exacerbation[60][61][62][63] - - - + + + - - + -
  • Tachypnea
  • Prolonged expiratory phase of respiration (decreased I:E ratio)
  • Seated position with use of extended arms to support the upper chest (tripod position)
  • +/- Pulsus paradoxus
 - - - -- - - - Chest X ray -
  • Loss of the normal pseudostratified structure of airway epithelium
  • Increase in the proportion of goblet cells
  • Fibrotic thickening of the sub-epithelial reticular basement membrane
  • Increased numbers of myofibroblasts
  • Increased vascularity
  • Increased airway smooth muscle mass
  • Increased extracellular matrix
Anaphylaxis[64][65][66][67][68] + -/+ + + + +/- - + + - - - - - - - - - - History of exposure to insect stings,food alllergy,rubber latex,food additives,,allergy to medications,physical factors such s excercise and cold
Histaminergic Angioedema[69][70][71][72][73] +/- +/- + + + + - + + - - - - - - - - - -
  • Take proper clinical history of previous similar episodes
  • Medication history
  • Any allergy to insects stings , foods or any ingestion within previous 24 hours
Medullary Thyroid Carcinoma[74][75][76][77] - +/- +/- +/- - - - - - - - - - - - -

For metastasis

-

Differential diagnosis based on diarrhea

The following table outlines the major differential diagnoses based on diarrhea as the major presenting symptom

Differential Diagnosis for Diarrhea predominant symptoms Clinical features Diagnosis
Crohn's disease
Ulcerative colitis
Microscopic colitis
Celiac disease
Neuroendocrine tumor
Hyperthyroidism
  • Serum TSH levels
Lactose intolerance
  • Avoidance trial, lactose breath test
Infectious causes
  • Abdominal discomfort, diarrhea especially in the setting of recent travel
Small bowel bacterial overgrowth
Clostridium difficile infection(Psuedomembranous colitis)

References

  1. ↑ Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS (2006). "Childhood functional gastrointestinal disorders: child/adolescent". Gastroenterology. 130 (5): 1527–37. doi:10.1053/j.gastro.2005.08.063. PMID 16678566.
  2. ↑ 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.
  3. ↑ Hamm LR, Sorrells SC, Harding JP, Northcutt AR, Heath AT, Kapke GF, Hunt CM, Mangel AW (1999). "Additional investigations fail to alter the diagnosis of irritable bowel syndrome in subjects fulfilling the Rome criteria". Am. J. Gastroenterol. 94 (5): 1279–82. doi:10.1111/j.1572-0241.1999.01077.x. PMID 10235207.
  4. ↑ Prott G, Shim L, Hansen R, Kellow J, Malcolm A (2010). "Relationships between pelvic floor symptoms and function in irritable bowel syndrome". Neurogastroenterol. Motil. 22 (7): 764–9. doi:10.1111/j.1365-2982.2010.01503.x. PMID 20456760.
  5. ↑ Voderholzer WA, Schatke W, Mühldorfer BE, Klauser AG, Birkner B, Müller-Lissner SA (1997). "Clinical response to dietary fiber treatment of chronic constipation". Am. J. Gastroenterol. 92 (1): 95–8. PMID 8995945.
  6. ↑ Spiller R, Camilleri M, Longstreth GF (2010). "Do the symptom-based, Rome criteria of irritable bowel syndrome lead to better diagnosis and treatment outcomes?". Clin. Gastroenterol. Hepatol. 8 (2): 125–9, discussion 129–36. doi:10.1016/j.cgh.2009.12.018. PMID 20152787.
  7. ↑ Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K (2010). "Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial". Am. J. Gastroenterol. 105 (4): 890–6. doi:10.1038/ajg.2010.53. PMC 3910270. PMID 20179692.
  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.
  9. ↑ 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.
  10. ↑ Mehdi Z, Sakineh E, Mohammad F, Mansour R, Alireza A (2012). "Celiac disease: Serologic prevalence in patients with irritable bowel syndrome". J Res Med Sci. 17 (9): 839–42. PMC 3697208. PMID 23826010.
  11. ↑ Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS (2004). "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. PMID 15188167.
  12. ↑ Stark D, van Hal S, Marriott D, Ellis J, Harkness J. (2007). "Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis". Int J Parasitol. 31 (1): 11–20. PMID 17070814.
  13. ↑ Drisko; et al. (2006). "Treating Irritable Bowel Syndrome with a Food Elimination Diet Followed by Food Challenge and Probiotics". Journal of the American College of Nutrition. 25 (6): 514–22. PMID 17229899.
  14. ↑ Vernia P, Ricciardi MR, Frandina C, Bilotta T, Frieri G (1995). "Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet". The Italian journal of gastroenterology. 27 (3): 117–21. PMID 7548919.
  15. ↑ http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/ - The United States National Institutes of Health Celiac Disease Page
  16. ↑ 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.
  17. ↑ 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.
  18. ↑ SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.
  19. ↑ Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS (2004). "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. PMID 15188167.
  20. ↑ Irvine AJ, Chey WD, Ford AC (2017). "Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis". Am. J. Gastroenterol. 112 (1): 65–76. doi:10.1038/ajg.2016.466. PMID 27753436.
  21. ↑ van Rheenen PF, Van de Vijver E, Fidler V (2010). "Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis". BMJ. 341: c3369. PMC 2904879. PMID 20634346.
  22. ↑ Slattery SA, Niaz O, Aziz Q, Ford AC, Farmer AD (2015). "Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea". Aliment. Pharmacol. Ther. 42 (1): 3–11. doi:10.1111/apt.13227. PMID 25913530.
  23. ↑ Canavan C, Card T, West J (2014). "The incidence of other gastroenterological disease following diagnosis of irritable bowel syndrome in the UK: a cohort study". PLoS ONE. 9 (9): e106478. doi:10.1371/journal.pone.0106478. PMC 4169512. PMID 25238408.
  24. ↑ Ford AC, Chey WD, Talley NJ, Malhotra A, Spiegel BM, Moayyedi P (2009). "Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis". Arch. Intern. Med. 169 (7): 651–8. doi:10.1001/archinternmed.2009.22. PMID 19364994.
  25. ↑ Ford AC, Spiegel BM, Talley NJ, Moayyedi P (2009). "Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis". Clin. Gastroenterol. Hepatol. 7 (12): 1279–86. doi:10.1016/j.cgh.2009.06.031. PMID 19602448.
  26. ↑ Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP (August 2018). "Carcinoid syndrome: update on the pathophysiology and treatment". Clinics (Sao Paulo). 73 (suppl 1): e490s. doi:10.6061/clinics/2018/e490s. PMC 6096975. PMID 30133565.
  27. ↑ Hegyi J, Schwartz RA, Hegyi V (January 2004). "Pellagra: dermatitis, dementia, and diarrhea". Int. J. Dermatol. 43 (1): 1–5. PMID 14693013.
  28. ↑ Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E (May 2004). "Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours". Nucl Med Commun. 25 (5): 445–9. PMID 15100502.
  29. ↑ Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E (May 2004). "Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours". Nucl Med Commun. 25 (5): 445–9. PMID 15100502.
  30. ↑ Bora, ManashKumar; Vithiavathi, S (2012). "Primary bronchial carcinoid: A rare differential diagnosis of pulmonary koch in young adult patient". Lung India. 29 (1): 59. doi:10.4103/0970-2113.92366. ISSN 0970-2113.
  31. ↑ Yazıcıoğlu A, Yekeler E, Bıcakcıoğlu P, Ozaydın E, Karaoğlanoğlu N (December 2012). "Synchronous bilateral multiple typical pulmonary carcinoid tumors: a unique case with 10 typical carcinoids". Balkan Med J. 29 (4): 450–2. doi:10.5152/balkanmedj.2012.081. PMC 4115868. PMID 25207053.
  32. ↑ Krausz Y, Keidar Z, Kogan I, Even-Sapir E, Bar-Shalom R, Engel A, Rubinstein R, Sachs J, Bocher M, Agranovicz S, Chisin R, Israel O (November 2003). "SPECT/CT hybrid imaging with 111In-pentetreotide in assessment of neuroendocrine tumours". Clin. Endocrinol. (Oxf). 59 (5): 565–73. PMID 14616879.
  33. ↑ van der Lely, Aart J.; Herder, Wouter W. de (2005). "Carcinoid syndrome: diagnosis and medical management". Arquivos Brasileiros de Endocrinologia & Metabologia. 49 (5): 850–860. doi:10.1590/S0004-27302005000500028. ISSN 0004-2730.
  34. ↑ Halperin DM, Shen C, Dasari A, Xu Y, Chu Y, Zhou S, Shih YT, Yao JC (April 2017). "Frequency of carcinoid syndrome at neuroendocrine tumour diagnosis: a population-based study". Lancet Oncol. 18 (4): 525–534. doi:10.1016/S1470-2045(17)30110-9. PMC 6066284. PMID 28238592.
  35. ↑ Sjöblom SM (September 1988). "Clinical presentation and prognosis of gastrointestinal carcinoid tumours". Scand. J. Gastroenterol. 23 (7): 779–87. PMID 3227292.
  36. ↑ Ganeshan D, Bhosale P, Yang T, Kundra V (October 2013). "Imaging features of carcinoid tumors of the gastrointestinal tract". AJR Am J Roentgenol. 201 (4): 773–86. doi:10.2214/AJR.12.9758. PMID 24059366.
  37. ↑ Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq
  38. ↑ Modlin IM, Kidd M, Latich I, Zikusoka MN, Shapiro MD (May 2005). "Current status of gastrointestinal carcinoids". Gastroenterology. 128 (6): 1717–51. PMID 15887161.
  39. ↑ Gustafsson BI, Kidd M, Chan A, Malfertheiner MV, Modlin IM (July 2008). "Bronchopulmonary neuroendocrine tumors". Cancer. 113 (1): 5–21. doi:10.1002/cncr.23542. PMID 18473355.
  40. ↑ Jeung, Mi-Young; Gasser, Bernard; Gangi, Afshin; Charneau, Dominique; Ducroq, Xavier; Kessler, Romain; Quoix, Elisabeth; Roy, Catherine (2002). "Bronchial Carcinoid Tumors of the Thorax: Spectrum of Radiologic Findings". RadioGraphics. 22 (2): 351–365. doi:10.1148/radiographics.22.2.g02mr01351. ISSN 0271-5333.
  41. ↑ Nessi R, Basso Ricci P, Basso Ricci S, Bosco M, Blanc M, Uslenghi C (April 1991). "Bronchial carcinoid tumors: radiologic observations in 49 cases". J Thorac Imaging. 6 (2): 47–53. PMID 1649924.
  42. ↑ Melmon KL, Sjoerdsma A, Mason DT (October 1965). "Distinctive clinical and therapeutic aspects of the syndrome associated with bronchial carcinoid tumors". Am. J. Med. 39 (4): 568–81. PMID 5831899.
  43. ↑ Ford AC, Forman D, Bailey AG, Axon AT, Moayyedi P (May 2008). "Irritable bowel syndrome: a 10-yr natural history of symptoms and factors that influence consultation behavior". Am. J. Gastroenterol. 103 (5): 1229–39, quiz 1240. doi:10.1111/j.1572-0241.2007.01740.x. PMID 18371141.
  44. ↑ Simren M, Palsson OS, Whitehead WE (April 2017). "Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice". Curr Gastroenterol Rep. 19 (4): 15. doi:10.1007/s11894-017-0554-0. PMC 5378729. PMID 28374308.
  45. ↑ "American Gastroenterological Association medical position statement: irritable bowel syndrome". Gastroenterology. 123 (6): 2105–7. December 2002. doi:10.1053/gast.2002.37095b. PMID 12454865.
  46. ↑ Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R (February 2016). "Bowel Disorders". Gastroenterology. doi:10.1053/j.gastro.2016.02.031. PMID 27144627.
  47. ↑ McLaughlin PD, Maher MM (July 2013). "Primary malignant diseases of the small intestine". AJR Am J Roentgenol. 201 (1): W9–14. doi:10.2214/AJR.12.8492. PMID 23789703.
  48. ↑ Hatzaras I, Palesty JA, Abir F, Sullivan P, Kozol RA, Dudrick SJ, Longo WE (March 2007). "Small-bowel tumors: epidemiologic and clinical characteristics of 1260 cases from the connecticut tumor registry". Arch Surg. 142 (3): 229–35. doi:10.1001/archsurg.142.3.229. PMID 17372046.
  49. ↑ Lepage C, Bouvier AM, Manfredi S, Dancourt V, Faivre J (December 2006). "Incidence and management of primary malignant small bowel cancers: a well-defined French population study". Am. J. Gastroenterol. 101 (12): 2826–32. doi:10.1111/j.1572-0241.2006.00854.x. PMID 17026561.
  50. ↑ Hara AK, Swartz PG (2009). "CT enterography of Crohn's disease". Abdom Imaging. 34 (3): 289–95. doi:10.1007/s00261-008-9443-1. PMID 18649092.
  51. ↑ Baumgart, Daniel C; Sandborn, William J (2012). "Crohn's disease". The Lancet. 380 (9853): 1590–1605. doi:10.1016/S0140-6736(12)60026-9. ISSN 0140-6736.
  52. ↑ Feuerstein, Joseph D.; Cheifetz, Adam S. (2017). "Crohn Disease: Epidemiology, Diagnosis, and Management". Mayo Clinic Proceedings. 92 (7): 1088–1103. doi:10.1016/j.mayocp.2017.04.010. ISSN 0025-6196.
  53. ↑ García-Bosch, O.; Ordás, I.; Aceituno, M.; Rodríguez, S.; Ramírez, A. M.; Gallego, M.; Ricart, E.; Rimola, J.; Panes, J. (2016). "Comparison of Diagnostic Accuracy and Impact of Magnetic Resonance Imaging and Colonoscopy for the Management of Crohn's Disease". Journal of Crohn's and Colitis. 10 (6): 663–669. doi:10.1093/ecco-jcc/jjw015. ISSN 1873-9946.
  54. ↑ Izikson, Leonid; English, Joseph C.; Zirwas, Matthew J. (2006). "The flushing patient: Differential diagnosis, workup, and treatment". Journal of the American Academy of Dermatology. 55 (2): 193–208. doi:10.1016/j.jaad.2005.07.057. ISSN 0190-9622.
  55. ↑ Hartmann, Karin; Escribano, Luis; Grattan, Clive; Brockow, Knut; Carter, Melody C.; Alvarez-Twose, Ivan; Matito, Almudena; Broesby-Olsen, Sigurd; Siebenhaar, Frank; Lange, Magdalena; Niedoszytko, Marek; Castells, Mariana; Oude Elberink, Joanna N.G.; Bonadonna, Patrizia; Zanotti, Roberta; Hornick, Jason L.; Torrelo, Antonio; Grabbe, Jürgen; Rabenhorst, Anja; Nedoszytko, Boguslaw; Butterfield, Joseph H.; Gotlib, Jason; Reiter, Andreas; Radia, Deepti; Hermine, Olivier; Sotlar, Karl; George, Tracy I.; Kristensen, Thomas K.; Kluin-Nelemans, Hanneke C.; Yavuz, Selim; Hägglund, Hans; Sperr, Wolfgang R.; Schwartz, Lawrence B.; Triggiani, Massimo; Maurer, Marcus; Nilsson, Gunnar; Horny, Hans-Peter; Arock, Michel; Orfao, Alberto; Metcalfe, Dean D.; Akin, Cem; Valent, Peter (2016). "Cutaneous manifestations in patients with mastocytosis: Consensus report of the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology". Journal of Allergy and Clinical Immunology. 137 (1): 35–45. doi:10.1016/j.jaci.2015.08.034. ISSN 0091-6749.
  56. ↑ Lee, Jason K; Whittaker, Scott J; Enns, Robert A; Zetler, Peter (2008). "Gastrointestinal manifestations of systemic mastocytosis". World Journal of Gastroenterology. 14 (45): 7005. doi:10.3748/wjg.14.7005. ISSN 1007-9327.
  57. ↑ Horan RF, Austen KF (March 1991). "Systemic mastocytosis: retrospective review of a decade's clinical experience at the Brigham and Women's Hospital". J. Invest. Dermatol. 96 (3): 5S–13S, discussion 13S–14S. PMID 2002264.
  58. ↑ Sokol, Harry; Georgin-Lavialle, Sophie; Grandpeix-Guyodo, Catherine; Canioni, Danielle; Barete, Stéphane; Dubreuil, Patrice; Lortholary, Olivier; Beaugerie, Laurent; Hermine, Olivier (2010). "Gastrointestinal involvement and manifestations in systemic mastocytosis". Inflammatory Bowel Diseases. 16 (7): 1247–1253. doi:10.1002/ibd.21218. ISSN 1078-0998.
  59. ↑ Bedeir A, Jukic DM, Wang L, Mullady DK, Regueiro M, Krasinskas AM (November 2006). "Systemic mastocytosis mimicking inflammatory bowel disease: A case report and discussion of gastrointestinal pathology in systemic mastocytosis". Am. J. Surg. Pathol. 30 (11): 1478–82. doi:10.1097/01.pas.0000213310.51553.d7. PMID 17063092.
  60. ↑ Fuhlbrigge A, Peden D, Apter AJ, Boushey HA, Camargo CA, Gern J, Heymann PW, Martinez FD, Mauger D, Teague WG, Blaisdell C (March 2012). "Asthma outcomes: exacerbations". J. Allergy Clin. Immunol. 129 (3 Suppl): S34–48. doi:10.1016/j.jaci.2011.12.983. PMC 3595577. PMID 22386508.
  61. ↑ Limb SL, Brown KC, Wood RA, Wise RA, Eggleston PA, Tonascia J, Adkinson NF (December 2005). "Irreversible lung function deficits in young adults with a history of childhood asthma". J. Allergy Clin. Immunol. 116 (6): 1213–9. doi:10.1016/j.jaci.2005.09.024. PMID 16337448.
  62. ↑ Aldington S, Beasley R (May 2007). "Asthma exacerbations. 5: assessment and management of severe asthma in adults in hospital". Thorax. 62 (5): 447–58. doi:10.1136/thx.2005.045203. PMC 2117186. PMID 17468458.
  63. ↑ Dougherty RH, Fahy JV (February 2009). "Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype". Clin. Exp. Allergy. 39 (2): 193–202. doi:10.1111/j.1365-2222.2008.03157.x. PMC 2730743. PMID 19187331.
  64. ↑ Peavy RD, Metcalfe DD (August 2008). "Understanding the mechanisms of anaphylaxis". Curr Opin Allergy Clin Immunol. 8 (4): 310–5. doi:10.1097/ACI.0b013e3283036a90. PMC 2683407. PMID 18596587.
  65. ↑ Tupper J, Visser S (October 2010). "Anaphylaxis: A review and update". Can Fam Physician. 56 (10): 1009–11. PMC 2954079. PMID 20944042.
  66. ↑ Kemp SF, Lockey RF (September 2002). "Anaphylaxis: a review of causes and mechanisms". J. Allergy Clin. Immunol. 110 (3): 341–8. PMID 12209078.
  67. ↑ Bjornsson HM, Graffeo CS (December 2010). "Improving diagnostic accuracy of anaphylaxis in the acute care setting". West J Emerg Med. 11 (5): 456–61. PMC 3027438. PMID 21293765.
  68. ↑ "Usefulness and Limitations of Sequential Serum Tryptase for the Diagnosis of Anaphylaxis in 102 Patients - FullText - International Archives of Allergy and Immunology 2013, Vol. 160, No. 2 - Karger Publishers".
  69. ↑ Busse PJ, Smith T (August 2017). "Histaminergic Angioedema". Immunol Allergy Clin North Am. 37 (3): 467–481. doi:10.1016/j.iac.2017.03.001. PMID 28687103.
  70. ↑ Hahn J, Hoffmann TK, Bock B, Nordmann-Kleiner M, Trainotti S, Greve J (July 2017). "Angioedema". Dtsch Arztebl Int. 114 (29–30): 489–496. doi:10.3238/arztebl.2017.0489. PMC 5569554. PMID 28818177.
  71. ↑ Bernstein JA, Cremonesi P, Hoffmann TK, Hollingsworth J (December 2017). "Angioedema in the emergency department: a practical guide to differential diagnosis and management". Int J Emerg Med. 10 (1): 15. doi:10.1186/s12245-017-0141-z. PMC 5389952. PMID 28405953.
  72. ↑ Bernstein JA, Moellman J (November 2012). "Emerging concepts in the diagnosis and treatment of patients with undifferentiated angioedema". Int J Emerg Med. 5 (1): 39. doi:10.1186/1865-1380-5-39. PMC 3518251. PMID 23131076.
  73. ↑ Kaplan AP (June 2008). "Angioedema". World Allergy Organ J. 1 (6): 103–13. doi:10.1097/WOX.0b013e31817aecbe. PMC 3651192. PMID 23282406.
  74. ↑ Pacini F, Castagna MG, Cipri C, Schlumberger M (August 2010). "Medullary thyroid carcinoma". Clin Oncol (R Coll Radiol). 22 (6): 475–85. doi:10.1016/j.clon.2010.05.002. PMID 20627492.
  75. ↑ Roy M, Chen H, Sippel RS (2013). "Current understanding and management of medullary thyroid cancer". Oncologist. 18 (10): 1093–100. doi:10.1634/theoncologist.2013-0053. PMC 3805151. PMID 24037980.
  76. ↑ Mian C, Perrino M, Colombo C, Cavedon E, Pennelli G, Ferrero S, De Leo S, Sarais C, Cacciatore C, Manfredi GI, Verga U, Iacobone M, De Pasquale L, Pelizzo MR, Vicentini L, Persani L, Fugazzola L (May 2014). "Refining calcium test for the diagnosis of medullary thyroid cancer: cutoffs, procedures, and safety". J. Clin. Endocrinol. Metab. 99 (5): 1656–64. doi:10.1210/jc.2013-4088. PMID 24552221.
  77. ↑ Bae YJ, Schaab M, Kratzsch J (2015). "Calcitonin as Biomarker for the Medullary Thyroid Carcinoma". Recent Results Cancer Res. 204: 117–37. doi:10.1007/978-3-319-22542-5_5. PMID 26494386.

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