Diagnosing the patient with abdominal pain and altered bowel habits: is it irritable bowel syndrome? (Problem-Oriented Diagnosis).

Publication: American Family Physician

Publication Date: 15-MAY-03

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COPYRIGHT 2003 American Academy of Family Physicians

Family physicians frequently see patients who have abdominal pain and altered bowel habits. It is a challenge to properly evaluate these patients and differentiate between irritable bowel syndrome (IBS) and life-threatening illnesses of the gastrointestinal tract.

IBS is one of the most common chronic gastrointestinal illnesses. IBS traditionally has been a diagnosis of exclusion, based on history, physical examination, and a negative battery of diagnostic studies. There are no structural or chemical markers for IBS. (1) Diagnostic tests are frequently overused because physicians are concerned about missing a life-threatening illness. (2)

Epidemiology

Americans spend $8 billion each year on medical costs related to IBS, (3) and absenteeism resulting from IBS significantly affects the work force. Studies have shown that IBS affects 3 to 22 percent of persons worldwide. (4) Symptoms are reported by 12 percent of Americans and are the cause of 20 to 50 percent of referrals to gastroenterology clinics. (5,6) Most people with IBS do not seek medical care. One half of patients develop symptoms before 35 years of age, and 40 percent of patients develop symptoms between 35 and 50 years of age. Onset in elderly persons is rare.

IBS is recognized in children, and many patients can trace their symptoms to childhood. One study found that 26 percent of children with recurrent abdominal pain were diagnosed with IBS, making it a common reason for school absenteeism. (7) Seventy percent of patients with IBS are women; 48 to 79 percent of patients with chronic pelvic pain, dyspareunia, dysmenorrhea, or a history of numerous abdominal surgeries also have IBS. (8) Women who have had a hysterectomy for chronic pelvic pain are twice as likely to have IBS. (2)

Signs and Symptoms

The most common symptoms of IBS include a change in the appearance or frequency of stools, and abdominal pain that is relieved by defecation. Other associated symptoms include bloating, distention, mucus in the stool, urgency, and a feeling of incomplete evacuation.

Based on stool-habit alteration, three subgroups of IBS have been described: constipation-predominant IBS, diarrhea-predominant IBS, and IBS with alternating bowel habits (also known as pain-predominant). (9) Although these groupings are useful for research purposes, symptom patterns may vary.

Factors Associated with IBS

A structural...

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