Irritable bowel syndrome differential diagnosis: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Sudarshana Datta (talk | contribs)
nocaptcha
3,577 edits
Sudarshana Datta (talk | contribs)
nocaptcha
3,577 edits
No edit summary
Line 27: Line 27:


===Differential Diagnosis of Irritable Bowel Syndrome on the basis of Constipation:===
===Differential Diagnosis of Irritable Bowel Syndrome on the basis of Constipation:===
The differential diagnosis of Irritable bowel Syndrome based on constipation is as follows:<ref name="pmid26913568">{{cite journal |vauthors=Guagnozzi D, Arias Á, Lucendo AJ |title=Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders |journal=Aliment. Pharmacol. Ther. |volume=43 |issue=8 |pages=851–862 |year=2016 |pmid=26913568 |doi=10.1111/apt.13573 |url=}}</ref><ref name="pmid27796144">{{cite journal |vauthors=Hilpüsch F, Johnsen PH, Goll R, Valle PC, Sørbye SW, Abelsen B |title=Microscopic colitis: a missed diagnosis among patients with moderate to severe irritable bowel syndrome |journal=Scand. J. Gastroenterol. |volume=52 |issue=2 |pages=173–177 |year=2017 |pmid=27796144 |doi=10.1080/00365521.2016.1242025 |url=}}</ref><ref name="pmid14201408">{{cite journal| author=SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA| title=EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME. | journal=Gastroenterology | year= 1964 | volume= 47 | issue=  | pages= 184-7 | pmid=14201408 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14201408  }} </ref><ref name="pmid16678566">{{cite journal |vauthors=Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS |title=Childhood functional gastrointestinal disorders: child/adolescent |journal=Gastroenterology |volume=130 |issue=5 |pages=1527–37 |year=2006 |pmid=16678566 |doi=10.1053/j.gastro.2005.08.063 |url=}}</ref><ref name="pmid12425553">{{cite journal |vauthors=Cash BD, Schoenfeld P, Chey WD |title=The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review |journal=Am. J. Gastroenterol. |volume=97 |issue=11 |pages=2812–9 |year=2002 |pmid=12425553 |doi=10.1111/j.1572-0241.2002.07027.x |url=}}</ref><ref name="pmid15188167">{{cite journal |vauthors=Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS |title=Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis |journal=Gastroenterology |volume=126 |issue=7 |pages=1721–32 |year=2004 |pmid=15188167 |doi= |url=}}</ref><ref name="pmid10235207">{{cite journal |vauthors=Hamm LR, Sorrells SC, Harding JP, Northcutt AR, Heath AT, Kapke GF, Hunt CM, Mangel AW |title=Additional investigations fail to alter the diagnosis of irritable bowel syndrome in subjects fulfilling the Rome criteria |journal=Am. J. Gastroenterol. |volume=94 |issue=5 |pages=1279–82 |year=1999 |pmid=10235207 |doi=10.1111/j.1572-0241.1999.01077.x |url=}}</ref><ref name="pmid20456760">{{cite journal |vauthors=Prott G, Shim L, Hansen R, Kellow J, Malcolm A |title=Relationships between pelvic floor symptoms and function in irritable bowel syndrome |journal=Neurogastroenterol. Motil. |volume=22 |issue=7 |pages=764–9 |year=2010 |pmid=20456760 |doi=10.1111/j.1365-2982.2010.01503.x |url=}}</ref><ref name="pmid8995945">{{cite journal |vauthors=Voderholzer WA, Schatke W, Mühldorfer BE, Klauser AG, Birkner B, Müller-Lissner SA |title=Clinical response to dietary fiber treatment of chronic constipation |journal=Am. J. Gastroenterol. |volume=92 |issue=1 |pages=95–8 |year=1997 |pmid=8995945 |doi= |url=}}</ref><ref name="pmid20152787">{{cite journal |vauthors=Spiller R, Camilleri M, Longstreth GF |title=Do the symptom-based, Rome criteria of irritable bowel syndrome lead to better diagnosis and treatment outcomes? |journal=Clin. Gastroenterol. Hepatol. |volume=8 |issue=2 |pages=125–9; discussion 129–36 |year=2010 |pmid=20152787 |doi=10.1016/j.cgh.2009.12.018 |url=}}</ref><ref name="pmid20179692">{{cite journal |vauthors=Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K |title=Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial |journal=Am. J. Gastroenterol. |volume=105 |issue=4 |pages=890–6 |year=2010 |pmid=20179692 |pmc=3910270 |doi=10.1038/ajg.2010.53 |url=}}</ref><ref name="pmid27753436">{{cite journal |vauthors=Irvine AJ, Chey WD, Ford AC |title=Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis |journal=Am. J. Gastroenterol. |volume=112 |issue=1 |pages=65–76 |year=2017 |pmid=27753436 |doi=10.1038/ajg.2016.466 |url=}}</ref><ref name="pmid20634346">{{cite journal |vauthors=van Rheenen PF, Van de Vijver E, Fidler V |title=Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis |journal=BMJ |volume=341 |issue= |pages=c3369 |year=2010 |pmid=20634346 |pmc=2904879 |doi= |url=}}</ref><ref name="pmid20179696">{{cite journal |vauthors=Chey WD, Nojkov B, Rubenstein JH, Dobhan RR, Greenson JK, Cash BD |title=The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial |journal=Am. J. Gastroenterol. |volume=105 |issue=4 |pages=859–65 |year=2010 |pmid=20179696 |pmc=2887227 |doi=10.1038/ajg.2010.55 |url=}}</ref><ref name="pmid25913530">{{cite journal |vauthors=Slattery SA, Niaz O, Aziz Q, Ford AC, Farmer AD |title=Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea |journal=Aliment. Pharmacol. Ther. |volume=42 |issue=1 |pages=3–11 |year=2015 |pmid=25913530 |doi=10.1111/apt.13227 |url=}}</ref><ref name="pmid25238408">{{cite journal |vauthors=Canavan C, Card T, West J |title=The incidence of other gastroenterological disease following diagnosis of irritable bowel syndrome in the UK: a cohort study |journal=PLoS ONE |volume=9 |issue=9 |pages=e106478 |year=2014 |pmid=25238408 |pmc=4169512 |doi=10.1371/journal.pone.0106478 |url=}}</ref><ref name="pmid23357491">{{cite journal |vauthors=Begtrup LM, Engsbro AL, Kjeldsen J, Larsen PV, Schaffalitzky de Muckadell O, Bytzer P, Jarbøl DE |title=A positive diagnostic strategy is noninferior to a strategy of exclusion for patients with irritable bowel syndrome |journal=Clin. Gastroenterol. Hepatol. |volume=11 |issue=8 |pages=956–62.e1 |year=2013 |pmid=23357491 |doi=10.1016/j.cgh.2012.12.038 |url=}}</ref><ref name="pmid19364994">{{cite journal |vauthors=Ford AC, Chey WD, Talley NJ, Malhotra A, Spiegel BM, Moayyedi P |title=Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis |journal=Arch. Intern. Med. |volume=169 |issue=7 |pages=651–8 |year=2009 |pmid=19364994 |doi=10.1001/archinternmed.2009.22 |url=}}</ref><ref name="pmid23826010">{{cite journal |vauthors=Mehdi Z, Sakineh E, Mohammad F, Mansour R, Alireza A |title=Celiac disease: Serologic prevalence in patients with irritable bowel syndrome |journal=J Res Med Sci |volume=17 |issue=9 |pages=839–42 |year=2012 |pmid=23826010 |pmc=3697208 |doi= |url=}}</ref><ref name="pmid19602448">{{cite journal |vauthors=Ford AC, Spiegel BM, Talley NJ, Moayyedi P |title=Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=12 |pages=1279–86 |year=2009 |pmid=19602448 |doi=10.1016/j.cgh.2009.06.031 |url=}}</ref>
The differential diagnosis of Irritable bowel Syndrome based on constipation is as follows:<ref name="pmid16678566">{{cite journal |vauthors=Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS |title=Childhood functional gastrointestinal disorders: child/adolescent |journal=Gastroenterology |volume=130 |issue=5 |pages=1527–37 |year=2006 |pmid=16678566 |doi=10.1053/j.gastro.2005.08.063 |url=}}</ref><ref name="pmid12425553">{{cite journal |vauthors=Cash BD, Schoenfeld P, Chey WD |title=The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review |journal=Am. J. Gastroenterol. |volume=97 |issue=11 |pages=2812–9 |year=2002 |pmid=12425553 |doi=10.1111/j.1572-0241.2002.07027.x |url=}}</ref><ref name="pmid10235207">{{cite journal |vauthors=Hamm LR, Sorrells SC, Harding JP, Northcutt AR, Heath AT, Kapke GF, Hunt CM, Mangel AW |title=Additional investigations fail to alter the diagnosis of irritable bowel syndrome in subjects fulfilling the Rome criteria |journal=Am. J. Gastroenterol. |volume=94 |issue=5 |pages=1279–82 |year=1999 |pmid=10235207 |doi=10.1111/j.1572-0241.1999.01077.x |url=}}</ref><ref name="pmid20456760">{{cite journal |vauthors=Prott G, Shim L, Hansen R, Kellow J, Malcolm A |title=Relationships between pelvic floor symptoms and function in irritable bowel syndrome |journal=Neurogastroenterol. Motil. |volume=22 |issue=7 |pages=764–9 |year=2010 |pmid=20456760 |doi=10.1111/j.1365-2982.2010.01503.x |url=}}</ref><ref name="pmid8995945">{{cite journal |vauthors=Voderholzer WA, Schatke W, Mühldorfer BE, Klauser AG, Birkner B, Müller-Lissner SA |title=Clinical response to dietary fiber treatment of chronic constipation |journal=Am. J. Gastroenterol. |volume=92 |issue=1 |pages=95–8 |year=1997 |pmid=8995945 |doi= |url=}}</ref><ref name="pmid20152787">{{cite journal |vauthors=Spiller R, Camilleri M, Longstreth GF |title=Do the symptom-based, Rome criteria of irritable bowel syndrome lead to better diagnosis and treatment outcomes? |journal=Clin. Gastroenterol. Hepatol. |volume=8 |issue=2 |pages=125–9; discussion 129–36 |year=2010 |pmid=20152787 |doi=10.1016/j.cgh.2009.12.018 |url=}}</ref><ref name="pmid20179692">{{cite journal |vauthors=Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K |title=Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial |journal=Am. J. Gastroenterol. |volume=105 |issue=4 |pages=890–6 |year=2010 |pmid=20179692 |pmc=3910270 |doi=10.1038/ajg.2010.53 |url=}}</ref><ref name="pmid20179696">{{cite journal |vauthors=Chey WD, Nojkov B, Rubenstein JH, Dobhan RR, Greenson JK, Cash BD |title=The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial |journal=Am. J. Gastroenterol. |volume=105 |issue=4 |pages=859–65 |year=2010 |pmid=20179696 |pmc=2887227 |doi=10.1038/ajg.2010.55 |url=}}</ref><ref name="pmid23357491">{{cite journal |vauthors=Begtrup LM, Engsbro AL, Kjeldsen J, Larsen PV, Schaffalitzky de Muckadell O, Bytzer P, Jarbøl DE |title=A positive diagnostic strategy is noninferior to a strategy of exclusion for patients with irritable bowel syndrome |journal=Clin. Gastroenterol. Hepatol. |volume=11 |issue=8 |pages=956–62.e1 |year=2013 |pmid=23357491 |doi=10.1016/j.cgh.2012.12.038 |url=}}</ref><ref name="pmid23826010">{{cite journal |vauthors=Mehdi Z, Sakineh E, Mohammad F, Mansour R, Alireza A |title=Celiac disease: Serologic prevalence in patients with irritable bowel syndrome |journal=J Res Med Sci |volume=17 |issue=9 |pages=839–42 |year=2012 |pmid=23826010 |pmc=3697208 |doi= |url=}}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
| valign="top" |
Line 73: Line 73:


=== '''Differential Diagnosis of Irritable Bowel Syndrome on the basis of Diarrhea:''' ===
=== '''Differential Diagnosis of Irritable Bowel Syndrome on the basis of Diarrhea:''' ===
The differential diagnosis of Irritable Bowel Syndrome based on diarrhea is as follows:<ref name="pmid26913568" /><ref name="pmid27796144" />
The differential diagnosis of Irritable Bowel Syndrome based on diarrhea is as follows:<ref name="pmid26913568">{{cite journal |vauthors=Guagnozzi D, Arias Á, Lucendo AJ |title=Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders |journal=Aliment. Pharmacol. Ther. |volume=43 |issue=8 |pages=851–862 |year=2016 |pmid=26913568 |doi=10.1111/apt.13573 |url=}}</ref><ref name="pmid27796144">{{cite journal |vauthors=Hilpüsch F, Johnsen PH, Goll R, Valle PC, Sørbye SW, Abelsen B |title=Microscopic colitis: a missed diagnosis among patients with moderate to severe irritable bowel syndrome |journal=Scand. J. Gastroenterol. |volume=52 |issue=2 |pages=173–177 |year=2017 |pmid=27796144 |doi=10.1080/00365521.2016.1242025 |url=}}</ref><ref name="pmid14201408">{{cite journal| author=SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA| title=EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME. | journal=Gastroenterology | year= 1964 | volume= 47 | issue=  | pages= 184-7 | pmid=14201408 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14201408  }} </ref><ref name="pmid15188167">{{cite journal |vauthors=Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS |title=Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis |journal=Gastroenterology |volume=126 |issue=7 |pages=1721–32 |year=2004 |pmid=15188167 |doi= |url=}}</ref><ref name="pmid27753436">{{cite journal |vauthors=Irvine AJ, Chey WD, Ford AC |title=Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis |journal=Am. J. Gastroenterol. |volume=112 |issue=1 |pages=65–76 |year=2017 |pmid=27753436 |doi=10.1038/ajg.2016.466 |url=}}</ref><ref name="pmid20634346">{{cite journal |vauthors=van Rheenen PF, Van de Vijver E, Fidler V |title=Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis |journal=BMJ |volume=341 |issue= |pages=c3369 |year=2010 |pmid=20634346 |pmc=2904879 |doi= |url=}}</ref><ref name="pmid25913530">{{cite journal |vauthors=Slattery SA, Niaz O, Aziz Q, Ford AC, Farmer AD |title=Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea |journal=Aliment. Pharmacol. Ther. |volume=42 |issue=1 |pages=3–11 |year=2015 |pmid=25913530 |doi=10.1111/apt.13227 |url=}}</ref><ref name="pmid25238408">{{cite journal |vauthors=Canavan C, Card T, West J |title=The incidence of other gastroenterological disease following diagnosis of irritable bowel syndrome in the UK: a cohort study |journal=PLoS ONE |volume=9 |issue=9 |pages=e106478 |year=2014 |pmid=25238408 |pmc=4169512 |doi=10.1371/journal.pone.0106478 |url=}}</ref><ref name="pmid19364994">{{cite journal |vauthors=Ford AC, Chey WD, Talley NJ, Malhotra A, Spiegel BM, Moayyedi P |title=Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis |journal=Arch. Intern. Med. |volume=169 |issue=7 |pages=651–8 |year=2009 |pmid=19364994 |doi=10.1001/archinternmed.2009.22 |url=}}</ref><ref name="pmid19602448">{{cite journal |vauthors=Ford AC, Spiegel BM, Talley NJ, Moayyedi P |title=Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=12 |pages=1279–86 |year=2009 |pmid=19602448 |doi=10.1016/j.cgh.2009.06.031 |url=}}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
| valign="top" |
Line 645: Line 645:
! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Functional
! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Functional
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Irritable Bowel Syndrome
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Irritable Bowel Syndrome
!style="padding: 5px 5px; background: #F5F5F5;" align="left"|-
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |-
!
!
!style="padding: 5px 5px; background: #F5F5F5;" align="left"|Diffuse
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
!style="padding: 5px 5px; background: #F5F5F5;" align="left"|<nowiki>-</nowiki>
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
!!style="padding: 5px 5px; background: #F5F5F5;" align="left"|-
! align="left" !style="padding: 5px 5px; background: #F5F5F5;" |-
!style="padding: 5px 5px; background: #F5F5F5;" align="left"|-
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |-
!style="padding: 5px 5px; background: #F5F5F5;" align="left"|-
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |-
!style="padding: 5px 5px; background: #F5F5F5;" align="left"|N
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
!style="padding: 5px 5px; background: #F5F5F5;" align="left"|
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
!style="padding: 5px 5px; background: #F5F5F5;" align="left"|
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 
[[Diagnosis|Clinical diagnosis]]
[[Diagnosis|Clinical diagnosis]]
* ROME III/IV criteria
* ROME III/IV criteria
* [[Pharmacological|Pharmacologic]] studies based criteria
* [[Pharmacological|Pharmacologic]] studies based criteria
!style="padding: 5px 5px; background: #F5F5F5;" align="left"|-
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |-
! style="padding: 5px 5px; background: #F5F5F5;" align="left"|High [[dietary fiber]],[[Osmotic]] [[laxatives]] and [[Antispasmodic]]<nowiki/>drugs  
! style="padding: 5px 5px; background: #F5F5F5;" align="left" |High [[dietary fiber]],[[Osmotic]] [[laxatives]] and [[Antispasmodic]]<nowiki/>drugs  
|-
|-
|}
|}
Line 718: Line 717:
{{WS}}
{{WS}}
[[Category: (name of the system)]]
[[Category: (name of the system)]]
|}

Revision as of 18:44, 1 November 2017

Irritable bowel syndrome Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Irritable bowel syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Monitoring

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Case Studies

Case #1

Irritable bowel syndrome differential diagnosis On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Irritable bowel syndrome differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Irritable bowel syndrome differential diagnosis

CDC on Irritable bowel syndrome differential diagnosis

Irritable bowel syndrome differential diagnosis in the news

Blogs on Irritable bowel syndrome differential diagnosis

Directions to Hospitals Treating Irritable bowel syndrome

Risk calculators and risk factors for Irritable bowel syndrome differential diagnosis

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

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 of Irritable Bowel Syndrome on the basis of Constipation:

The differential diagnosis of Irritable bowel Syndrome based on constipation 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
  • Fatigue, increased sensitivity to cold, dry skin, constipation, weight gain, puffy face, muscle weakness, hoarseness
Medication
  • Medication history.
Neurologic disease
  • History and neurologic examination
Pelvic floor dysfunction
  • Straining, self digitation
Colonic inertia

Differential Diagnosis of Irritable Bowel Syndrome on the basis of Diarrhea:

The differential diagnosis of Irritable Bowel Syndrome based on diarrhea is as follows:[11][12][13][14][15][16][17][18][19][20]

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
Infectious causes
  • Abdominal discomfort, diarrhea especially in the setting of recent travel
Small bowel bacterial overgrowth
Clostridium difficile infection(Psuedomembranous colitis)

The diffrentials of chronic watery diarrhea are as follows:

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
  • Onset associated with change in appearance of stool

History of straining is also common

Clinical diagnosis 
Template:WikiDoc Sources

Differential diagnosis of abdominal pain

The differential diagnosis based on abdominal pain are as follows:

Classification of acute abdomen based

on etiology

Presentation Clinical findings Diagnosis Comments
Fever Rigors and Chills Abdominal Pain Jaundice Hypotension Guarding Rebound Tenderness Bowel sounds Other findings Lab Findings Imaging
Common causes of

Peritonitis

Spontaneous bacterial peritonitis + Diffuse − − − − Hypoactive
  • Ascitic fluid PMN>250 cells/mm³
  • Culture: Positive for single organism
 Ultrasound for evaluation of liver cirrhosis -
Perforated gastric and duodenal ulcer + Diffuse − + + + N
    • Glucose < 50mg/dl
    • Total protein > 1g/dl
 Air under diaphragm in upright CXR Upper GI endoscopy for diagnosis
Acute suppurative cholangitis + + RUQ + + + + ±
Acute cholangitis + − RUQ + − − − N Abnormal LFT Ultrasound shows biliary dilatation Biliary drainage (ERCP) + IV antibiotics
Acute cholecystitis + RUQ + − − Hypoactive Ultrasound shows gallstone and evidence of inflammation Murphy’s sign
Acute pancreatitis + Epigastric ± − − N Increased amylase / lipase Ultrasound shows evidence of inflammation Pain radiation to back
Acute appendicitis + RLQ − + + Hypoactive Leukocytosis Ultrasound shows evidence of inflammation Nausea & vomiting, decreased appetite
Acute diverticulitis + LLQ ± + − Hypoactive Leukocytosis CT scan and ultrasound shows evidence of inflammation
Hollow Viscous Obstruction Small intestine obstruction − Diffuse − + ± Hyperactive then absent Leukocytosis Abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Gall stone disease/Cholelithiasis ± −
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 - - - Hyperactive Leukocytosis and lactic acidosis CT scan Nausea & vomiting, normal physical examination
Acute ischemic colitis ± Diffuse - + + Hyperactive then absent Leukocytosis CT scan Nausea & vomiting
Hemorrhagic causes Ruptured abdominal aortic aneurysm - Diffuse - - - N Normal CT scan Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage - Diffuse - - - N Anemia CT scan History of trauma
Gynaecological Causes Fallopian tube Acute salpingitis + LLQ/ RLQ − ± ± N Leukocytosis Pelvic ultrasound Vaginal discharge
Ovarian cyst complications Torsion of the cyst - RLQ / LLQ - ± ± N Increased ESR and CRP Ultrasound Sudden onset sever pain with nausea and vomiting
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
Functional Irritable Bowel Syndrome - Diffuse - - - - N

Clinical diagnosis

- High dietary fiber,Osmotic laxatives and Antispasmodicdrugs

The following is a list of diseases that present with acute onset severe lower abdominal pain:

Disease Findings
Ectopic pregnancy History of missed menses, positive pregnancy test, ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.[21]
Appendicitis Pain localized to the right iliac fossa, vomiting, abdominal ultrasound sensitivity for diagnosis of acute appendicitis is 75% to 90%.[22]
Rupturedovarian cyst Usually spontaneous, can follow history of trauma, mild chronic lower abdominal discomfort may suddenly intensify, ultrasound is diagnostic.[23]
Ovarian cyst torsion Presents with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.[24]
Hemorrhagic ovarian cyst Presents with localized abdominal pain, nausea and vomiting. Hypovolemic shock may be present, abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.[24]
Endometriosis Presents with cyclic pain that is exacerbated by onset of menses, dyspareunia. laparoscopic exploration is diagnostic.[24]
Acute cystitis Presents with features of increased urinary frequency, urgency, dysuria, and suprapubic pain.[25][26]

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. ↑ 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.
  12. ↑ 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.
  13. ↑ SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ 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.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ Morin L, Cargill YM, Glanc P (2016). "Ultrasound Evaluation of First Trimester Complications of Pregnancy". J Obstet Gynaecol Can. 38 (10): 982–988. doi:10.1016/j.jogc.2016.06.001. PMID 27720100.
  22. ↑ Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C (1994). "Acute appendicitis: CT and US correlation in 100 patients". Radiology. 190 (1): 31–5. doi:10.1148/radiology.190.1.8259423. PMID 8259423.
  23. ↑ Bottomley C, Bourne T (2009). "Diagnosis and management of ovarian cyst accidents". Best Pract Res Clin Obstet Gynaecol. 23 (5): 711–24. doi:10.1016/j.bpobgyn.2009.02.001. PMID 19299205.
  24. ↑ 24.0 24.1 24.2 Bhavsar AK, Gelner EJ, Shorma T (2016). "Common Questions About the Evaluation of Acute Pelvic Pain". Am Fam Physician. 93 (1): 41–8. PMID 26760839.
  25. ↑ {{Cite journal | author = W. E. Stamm | title = Etiology and management of the acute urethral syndrome | journal = Sexually transmitted diseases | volume = 8 | issue = 3 | pages = 235–238 | year = 1981 | month = July-September | pmid = 7292216
  26. ↑ {{Cite journal | author = W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes | title = Causes of the acute urethral syndrome in women | journal = The New England journal of medicine | volume = 303 | issue = 8 | pages = 409–415 | year = 1980 | month = August | doi = 10.1056/NEJM198008213030801 | pmid = 6993946

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Irritable_bowel_syndrome_differential_diagnosis&oldid=1382739"