Irritable Bowel Syndrome Differential Diagnoses

  • Author: Jenifer K Lehrer, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: May 4, 2012
 
 

Diagnostic Considerations

Manning and associates established 6 criteria to distinguish irritable bowel syndrome from organic bowel disease.[13] Although historically important, these criteria are insensitive (58%), nonspecific (74%), and less reliable in men. The Manning criteria are as follows:

  • Onset of pain associated with more frequent bowel movements
  • Onset of pain associated with looser bowel movements
  • Pain relieved by defecation
  • Visible abdominal bloating
  • Subjective sensation of incomplete evacuation more than 25% of the time
  • Mucorrhea more than 25% of the time

Other problems to consider include the following:

  • Fructose intolerance
  • Gastrinoma
  • Infectious colitis
  • Medication adverse effects
  • Secretory diarrhea
  • VIPoma

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Jenifer K Lehrer, MD  Attending Physician, Department of Gastroenterology and Hepatology, Aria Health System, Philadelphia

Jenifer K Lehrer, MD, is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Gary R Lichtenstein, MD  Director of Inflammatory Bowel Disease Center, Professor, Department of Internal Medicine, University of Pennsylvania

Gary R Lichtenstein, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Rajeev Vasudeva, MD, FACG  Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine

Rajeev Vasudeva, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Columbia Medical Society, South Carolina Gastroenterology Association, and South Carolina Medical Association

Disclosure: Pricara Honoraria Speaking and teaching; UCB Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Douglas M Heuman, MD, FACP, FACG, AGAF  Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

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  2. Miller V, Hopkins L, Whorwell PJ. Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. Dec 2004;2(12):1064-8. [Medline].

  3. Bercik P, Verdu EF, Collins SM. Is irritable bowel syndrome a low-grade inflammatory bowel disease?. Gastroenterol Clin North Am. Jun 2005;34(2):235-45, vi-vii. [Medline].

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  6. Kassinen A, Krogius-Kurikka L, Mäkivuokko H, Rinttilä T, Paulin L, Corander J, et al. The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects. Gastroenterology. Jul 2007;133(1):24-33. [Medline].

  7. Camilleri M. Functional Gastrointestinal Disorders: Novel Insights and Treatments. Medscape General Medicine. 1999. Medscape. Available at http://www.medscape.com/viewarticle/717346. Accessed September 20, 2010.

  8. Wensaas KA, Langeland N, Hanevik K, et al. Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic cohort study. Gut. Sep 12 2011;[Medline].

  9. Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study. Am J Gastroenterol. Feb 2003;98(2):412-9. [Medline].

  10. Shepherd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol. Jul 2008;6(7):765-71. [Medline].

  11. Khashan AS, Quigley EM, McNamee R, McCarthy FP, Shanahan F, Kenny LC. Increased Risk of Miscarriage and Ectopic Pregnancy Among Women With Irritable Bowel Syndrome. Clin Gastroenterol Hepatol. Feb 25 2012;[Medline].

  12. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. Apr 2006;130(5):1480-91. [Medline].

  13. Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J. Sep 2 1978;2(6138):653-4. [Medline]. [Full Text].

  14. Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. Jan 2009;104 Suppl 1:S1-35. [Medline].

  15. Ruepert L, Quartero AO, de Wit NJ, et al. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev. Aug 10 2011;CD003460. [Medline].

  16. Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. Mar 2011;106(3):508-14. [Medline].

  17. [Best Evidence] Zijdenbos IL, de Wit NJ, van der Heijden GJ, Rubin G, Quartero AO. Psychological treatments for the management of irritable bowel syndrome. Cochrane Database Syst Rev. Jan 21 2009;CD006442. [Medline].

  18. [Best Evidence] Ford AC, Talley NJ, Schoenfeld PS, Quigley EM, Moayyedi P. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut. Mar 2009;58(3):367-78. [Medline].

  19. Menees SB, Maneerattannaporn M, Kim HM, Chey WD. The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. Jan 2012;107(1):28-35. [Medline].

  20. Pimentel M, Lembo A, Chey WD, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. Jan 6 2011;364(1):22-32. [Medline].

  21. Chang L, Tong K, Ameen V. Ischemic colitis and complications of constipation associated with the use of alosetron under a risk management plan: clinical characteristics, outcomes, and incidences. Am J Gastroenterol. Apr 2010;105(4):866-75. [Medline].

  22. Psychosocial Alarm Questionnaire for the Functional GI disorders. Am J Gastro. 2010;105(4): 795-7. Appendix A.

 
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