Source : Ford AC et al 2017 1 |
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movement . There is no specific altered bowel habit pattern that is characteristic of IBS . The bowel habits can include loose or firm small stools , and frequency can range from many bowel actions per day to very infrequent bowel actions .
The international consensus diagnostic criteria for IBS , the Rome criteria , appear in box 1 . 25
Note , however , that these criteria are designed for research purposes , not clinical care , so clinicians should not get too caught up in strictly adhering to the Rome criteria for diagnosing IBS .
Many clinicians find it challenging to confidently make a diagnosis of IBS without prior testing , for fear an alternative pathology may be missed . Clinicians can be reassured that patients presenting without red flags ( see box 2 ) are unlikely to have significant pathology . A large prospective case-controlled study of patients with non-constipated IBS who underwent colonoscopy showed these patients were not more likely to have significant pathology . 26 This has also been demonstrated in longitudinal follow-up studies of patients presenting with symptoms of IBS . 27
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Red flags and non-invasive testing
Whether red flags are present or
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not , it is reasonable to perform basic non-invasive testing . This could include FBC , C-reactive protein , LFTs , thyroid function test and EUC . 24 This can be paired with a faecal calprotectin and coeliac serology . Undiagnosed coeliac disease is |
Figure 4 . Irritable bowel syndrome . |
common among patients presenting with symptoms of presumed IBS . 28 Inflammatory bowel disease is unlikely when a patient has a normal faecal calprotectin result . It is worthwhile confidently explaining the probable diagnosis of IBS before |
the completion of biochemical testing ; this frames a positive discussion about IBS and its treatment at future consultations .
When red flags ( see box 2 ) are present , exclude alternative diagnoses with further testing before
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establishing the diagnosis of IBS .
Patients do not require endoscopy ( gastroscopy and / or colonoscopy ) to confirm the diagnosis of IBS . Do not perform faecal occult blood tests in patients presenting with symptoms of IBS , as
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this is primarily designed as a screening tool . 29
If gastroscopy and / or colonoscopy is performed , reassure patients to prevent further unnecessary testing . Advise patients that IBS is not associated with an increased risk
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