Diagnosis Of Irritable Bowel Syndrome (IBS)
How is IBS diagnosed?
Because there is no biologic marker or a blood test or an x-ray that we can use to diagnose IBS in all patients with IBS, we use standardized symptom based diagnostic criteria. The patients have to meet these symptom criteria to meet the diagnosis of IBS. The diagnostic criteria that's used right now is called the Rome III criteria for IBS, and Rome is a foundation, a group of experts, that developed these criteria based on evidence, medicine, and expert opinion. To meet the IBS diagnosis, the patient has to have symptoms for at least six months. They have to have had active symptoms for the past three months, and these symptoms are that you have to have at least three days per month of abdominal pain and/or discomfort. The abdominal pain and/or discomfort has to be associated with two out of the three following features: one, it has to be relieved with defecation, or two, the pain or discomfort is associated with a change in stool frequency less than three times a week or more than three times a day, or three, the abdominal pain discomfort is associated with a change in stool form, meaning loose watery stools or hard lumpy stools. If the patients have abdominal pain or discomfort associated with two out of those three criteria, they actually meet the criteria for IBS.
Can my family doctor diagnose IBS or do I need to see a specialist?
Any healthcare provider that knows the diagnostic criteria of IBS can diagnose IBS. We have found that most physicians, whether they're specialists or primary care physicians, don't actually use their own criteria. They do recognize that chronic or recurring abdominal pain associated with a change in bowel habits most likely signifies IBS. But to actually determine the number of healthcare providers that use the standard criteria, I think most don't. I think it's usually used by experts or for research purposes but any physician can make that diagnosis. It would be good to increase the awareness and education of physicians, which is being done, so everyone's familiar with those criteria and also to simplify the criteria so it's not so difficult to remember.
What symptoms lead to a possible diagnosis of IBS?
Symptoms that lead to a possible diagnosis of IBS are the symptoms that actually are used to make that diagnosis, because it's a symptom based diagnosis. So it's having chronic or recurrent dominal pain, or discomfort, or both. But the pain and discomfort has to be linked to change above habits. So diary anticipation, that's the important part in leading to a possible diagnosis of IBS, a link of pain with change of above habits.
What symptoms lead to a definite diagnosis of IBS?
The definitive diagnosis of IBS is actually made by the Rome Criteria, and these are symptom-based criteria. The one that we use right now is the Rome 3 criteria, so the patients have to have abdominal pain at least 3 days per month for the past 6 months. And at least have symptoms that are current and active for the last 3 months. The pain and discomfort has to be linked to 2 of 3 criteria. It has to be relieved with bowel movement, so after you go to the bathroom, the pain goes away at least temporarily. It has to be associated with a change in stool frequency, meaning that you have to go more than 3 times a day, or less than 3 times a week. And the last criteria is the pain or discomfort has to be associated with a change in stool form. So it's like lumpy, hard stools or loose, watery stools.
What is the 'Rome Criteria'?
The Rome Criteria are criteria that were developed by a panel of experts. It's called Rome Foundation because they actually met in Rome when they developed the criteria. It's based on evidence - scientific evidence - and also expert opinion. These are the criteria that were thought to be indicative of IBS versus another condition that can mimic the symptoms such as inflammatory bowel disease or colon cancer.
Are there medical tests to diagnose for IBS?
There currently are no medical tests to diagnose IBS, it's all based on symptoms. We do run some medical tests just to exclude other conditions or to make sure the patient doesn't have what we call red flags or alarm signs to suggest that they have a diagnosis other than IBS. A couple of these tests include a complete blood count, which would determine if a patient is anemic or not; a sylliac screw panel which is blood test to look for the antibodies for sylliac screw which is a disease which causes symptoms similar to IBS. Also, sometimes we do a colonoscopy if the patient has any alarm signs to suggest they may have colitis or colon cancer. But these aren't actually required tests, we determine if the patient needs them based on the symptoms that they present us with.
What is a 'lower gastrointestinal series'?
A lower gastrointestinal series is basically a barium enema where you put a radio-opaque dye in the rectum. It moves through the colon, so it gives you a view of what the colon looks like. You're essentially determining if there is any anatomical or structural abnormalities of the colon.
What is a 'colonoscopy'?
A colonoscopy is a test where the patient undergoes a bowel preparation, so their colon is clean when you are visualizing their colon. There's a long, flexible instrument with a camera lens on the end called a colonoscope, and it's inserted into the rectum and colon. Then you're able to visualize the lining of the colon, looking for polyps, or any mass lesions and inflammation. So it's a very good test for diagnosis and also for therapy, if you need to remove a polyp for example.
What should I do if my doctor diagnoses me with IBS?
When a person is diagnosed with IBS it's important to gain information about the condition, because that helps understand what's going on in the body and also what the patient can do to help better manage their symptoms. Obtaining educational materials is really important, as is discussing with the doctor any questions or concerns the patient may have, because a lot of times IBS is associated with patients not really understanding what they have and being told many times it's all in their head. They need to understand that it's a real condition and there's true physiologic changes that are in the bowel that are responsible for their symptoms. Also, they should discuss with their physician what they can do to better manage their symptoms, whether it's with medications or other types of treatment interventions.
I have been diagnosed with IBS, but tests found nothing wrong, do I need more tests?
In general, studies have shown that you don't need to do an aggressive diagnostic workup to rule out other conditions. If the patient meets the Rome Criteria, which are the symptom based diagnostic criteria, and they don't have these other alarm signs, it's very specific for the diagnosis of IBS. The tests that we have now are fairly limited. They are looking for other conditions. We don't have a test that we could use right now to diagnose IBS.
My doctor prescribed an antidepressant to treat my IBS, does that mean I have a psychological disorder?
Psychological symptoms are not predominant in every patient with IBS. It's more common in patients with severe cases of IBS. But antidepressants are often prescribed for the treatment of IBS because not only can they help associate it with psychological stress that can be associated with the condition, but they have also been shown to decrease pain, and also normalize some of the bowel symptoms. So they work directly on the brain-gut mechanisms that seem to be altered or deregulated in IBS, and it's not specifically for only mood.
Is IBS considered a disability?
Irritable Bowel Syndrome (IBS) in some situations and in some patients is considered a disability. Those patients with very severe symptoms and the symptoms will completely impact their quality of life, such as they are unable to work, then they can actually become disabled. But there's a vast number of Irritable Bowel Syndrome (IBS) patients that actually have a normal functioning life if they can manage their symptoms.