Irritable bowel syndrome laboratory findings: Difference between revisions
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==Laboratory Findings== | ==Laboratory Findings== | ||
* The diagnosis of [[Irritable bowel syndrome|IBS]] is based on clinical [[Symptom|symptoms]] and elimination of other organic [[Gastrointestinal tract|gastrointestinal]] diseases. This is due to lack of definitive [[Radiologic sign|radiologic]] or [[Medical laboratory|laboratory]] diagnostic tests in [[Irritable bowel syndrome|IBS]].<ref name="pmid16678561">{{cite journal |vauthors=Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC |title=Functional bowel disorders |journal=Gastroenterology |volume=130 |issue=5 |pages=1480–91 |year=2006 |pmid=16678561 |doi=10.1053/j.gastro.2005.11.061 |url=}}</ref><ref name="pmid12454866">{{cite journal |vauthors=Drossman DA, Camilleri M, Mayer EA, Whitehead WE |title=AGA technical review on irritable bowel syndrome |journal=Gastroenterology |volume=123 |issue=6 |pages=2108–31 |year=2002 |pmid=12454866 |doi=10.1053/gast.2002.37095 |url=}}</ref><ref name="pmid17488783">{{cite journal |vauthors=Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P |title=Guidelines on the irritable bowel syndrome: mechanisms and practical management |journal=Gut |volume=56 |issue=12 |pages=1770–98 |year=2007 |pmid=17488783 |pmc=2095723 |doi=10.1136/gut.2007.119446 |url=}}</ref><ref name="pmid12425586">{{cite journal |vauthors=Brandt LJ, Bjorkman D, Fennerty MB, Locke GR, Olden K, Peterson W, Quigley E, Schoenfeld P, Schuster M, Talley N |title=Systematic review on the management of irritable bowel syndrome in North America |journal=Am. J. Gastroenterol. |volume=97 |issue=11 Suppl |pages=S7–26 |year=2002 |pmid=12425586 |doi= |url=}}</ref><ref name="YAWN_2001">{{cite journal |author=Yawn BP, Lydick E, Locke GR, Wollan PC, Bertram SL, Kurland MJ|title=Do published guidelines for evaluation of irritable bowel syndrome reflect practice? |journal=BMC gastroenterology |volume=1|issue= |pages=11 |year=2001 |pmid=11701092 |doi=}}</ref> | |||
* If the history and physical exam are suggestive of IBS in the absence of alarm features, the following tests rule out organic causes by 97 percent: | |||
** CBC- normal in IBS | |||
** Occult blood test- normal in IBS | |||
** Complete metabolic panel- normal | |||
** ESR- normal | |||
* Additional tests may be costly and harmful in young patients with typical IBS symtoms, in the absence of alarm features. | |||
* To determine the aggressiveness of the diagnostic evaluation, the American Gastroenterological Association has defined certain factors that must be considered: | |||
** Degree of psychosocial impairment | |||
** Age and sex of the patient | |||
** Family history of colorectal cancer | |||
** Prior diagnostic studies | |||
** Duration of symptoms | |||
** Change in symptoms over time | |||
* In patients that require aggressive diagnostic evaluation, additional diseases need to be ruled out: | |||
** Celiac disease: Serological screening | |||
** IBD: | |||
*** Inflammatory markers(ESR, C-reactive protein, plasma viscosity) are likely to be raised | |||
*** LFTs- decreased serum albumin | |||
*** Complete blood count shows IDA due to blood loss | |||
** Giardiasis: prevalent in developing countries | |||
*** stool sample for microscopy | |||
*** culture with specific request to look for ova, cyst and parasites | |||
* Other organic causes are suspected if lab investigations show the following: | |||
Serological screening | ** Complete blood count- evidence of anemia | ||
** ESR raised | |||
Inflammatory markers(ESR, C-reactive protein, plasma viscosity) are likely to be raised | ** Stool Volume >200–300 mL/day | ||
** Stool content: Blood and leukocytes | |||
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This disorder should be screened for with | This disorder should be screened for with | ||
Revision as of 18:52, 7 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
OR
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
OR
[Test] is usually normal among patients with [disease name].
OR
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
OR
There are no diagnostic laboratory findings associated with [disease name].
Laboratory Findings
- The diagnosis of IBS is based on clinical symptoms and elimination of other organic gastrointestinal diseases. This is due to lack of definitive radiologic or laboratory diagnostic tests in IBS.[1][2][3][4][5]
- If the history and physical exam are suggestive of IBS in the absence of alarm features, the following tests rule out organic causes by 97 percent:
- CBC- normal in IBS
- Occult blood test- normal in IBS
- Complete metabolic panel- normal
- ESR- normal
- Additional tests may be costly and harmful in young patients with typical IBS symtoms, in the absence of alarm features.
- To determine the aggressiveness of the diagnostic evaluation, the American Gastroenterological Association has defined certain factors that must be considered:
- Degree of psychosocial impairment
- Age and sex of the patient
- Family history of colorectal cancer
- Prior diagnostic studies
- Duration of symptoms
- Change in symptoms over time
- In patients that require aggressive diagnostic evaluation, additional diseases need to be ruled out:
- Celiac disease: Serological screening
- IBD:
- Inflammatory markers(ESR, C-reactive protein, plasma viscosity) are likely to be raised
- LFTs- decreased serum albumin
- Complete blood count shows IDA due to blood loss
- Giardiasis: prevalent in developing countries
- stool sample for microscopy
- culture with specific request to look for ova, cyst and parasites
- Other organic causes are suspected if lab investigations show the following:
- Complete blood count- evidence of anemia
- ESR raised
- Stool Volume >200–300 mL/day
- Stool content: Blood and leukocytes
This disorder should be screened for with
antiendomysial antibodies. A full blood count, renal and
liver function tests, thyroid function testing, and
investigation of stool sample for parasites all have very
low yields but are inexpensive.109
Most patients should have a complete blood count and
sigmoidoscopic examination; in addition, stool specimens should
be examined for ova and parasites in those who have diarrhea.
In patients with persistent diarrhea not responding to simple
antidiarrheal agents, a sigmoid colon biopsy should be performed
to rule out microscopic colitis.
In those age >40 years, an aircontrast
barium enema or colonoscopy should also be performed.
If the main symptoms are diarrhea and increased gas, the possibility
of lactase deficiency should be ruled out with a hydrogen breath test
or with evaluation after a 3-week lactose-free diet.
Some patients with IBS-D may have undiagnosed celiac sprue. Because the symptoms
of celiac sprue respond to a gluten-free diet, testing for celiac
sprue in IBS may prevent years of morbidity and attendant expense.
Decision-analysis studies show that serology testing for celiac sprue
in patients with IBS-D has an acceptable cost when the prevalence
of celiac sprue is >1% and is the dominant strategy when the prevalence
is >8%.
OR
- An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
- [Test] is usually normal among patients with [disease name].
- Laboratory findings consistent with the diagnosis of [disease name] include:
- [Abnormal test 1]
- [Abnormal test 2]
- [Abnormal test 3]
- Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
References
- ↑ Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006). "Functional bowel disorders". Gastroenterology. 130 (5): 1480–91. doi:10.1053/j.gastro.2005.11.061. PMID 16678561.
- ↑ Drossman DA, Camilleri M, Mayer EA, Whitehead WE (2002). "AGA technical review on irritable bowel syndrome". Gastroenterology. 123 (6): 2108–31. doi:10.1053/gast.2002.37095. PMID 12454866.
- ↑ Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P (2007). "Guidelines on the irritable bowel syndrome: mechanisms and practical management". Gut. 56 (12): 1770–98. doi:10.1136/gut.2007.119446. PMC 2095723. PMID 17488783.
- ↑ Brandt LJ, Bjorkman D, Fennerty MB, Locke GR, Olden K, Peterson W, Quigley E, Schoenfeld P, Schuster M, Talley N (2002). "Systematic review on the management of irritable bowel syndrome in North America". Am. J. Gastroenterol. 97 (11 Suppl): S7–26. PMID 12425586.
- ↑ Yawn BP, Lydick E, Locke GR, Wollan PC, Bertram SL, Kurland MJ (2001). "Do published guidelines for evaluation of irritable bowel syndrome reflect practice?". BMC gastroenterology. 1: 11. PMID 11701092.