Pediatric Irritable Bowel Syndrome Workup

  • Author: Mohammad F El-Baba, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Dec 22, 2010
 

Laboratory Studies

  • No specific laboratory markers are noted for irritable bowel syndrome (IBS). Patients who have characteristic symptoms and meet the Rome criteria for irritable bowel syndrome (see History) do not require a thorough diagnostic evaluation. A more aggressive approach is recommended for individuals with atypical symptoms, those with a rapidly progressive course, or when the index of suspicion for an organic disease is high.
  • In classic cases, a limited screen for organic disease is reassuring and should consist of the following:
    • CBC count
    • Erythrocyte sedimentation rate
    • Stool studies for ova and parasites
    • Stool cultures and stool Clostridium difficile toxin assay, if clinically indicated
    • A breath hydrogen test or a trial of dietary lactose restriction to exclude lactose intolerance
  • The following laboratory tests are indicated in special instances:
    • Lead level assessment
    • Celiac serologic tests
    • Serum immune markers for inflammatory bowel disease
    • Thyroid function tests
    • Tests for Helicobacter pylori (ie, serum antibody titers, urea breath test)
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Imaging Studies

  • Plain abdominal radiography is recommended for patients with pain-predominant symptoms. Perform plain abdominal radiography during a pain episode to exclude intermittent obstruction.
  • Upper GI study with small-bowel follow through is a useful study if Crohn disease or celiac sprue is suggested.
  • Barium enema can be useful for patients in whom Hirschsprung disease or congenital structural anomalies of the colon are suspected. Barium enema is also indicated in older patients (>50 y) because of the increased likelihood of colonic neoplasms.
  • Gastric scintigraphy is indicated for selected patients to evaluate for gastroparesis.
  • Abdominal ultrasonography is suggested for patients in whom biliary disease is suspected. It has high sensitivity and specificity for gallstones. It can also detect gallbladder wall thickening.
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Other Tests

  • GI manometry can assist in evaluating patients in whom gastroparesis or intestinal pseudoobstruction is suspected.
  • Anorectal manometry is useful to screen patients in whom Hirschsprung disease is suspected.
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Procedures

  • Sigmoidoscopy or complete colonoscopy is useful to evaluate for inflammatory conditions such as ulcerative colitis and microscopic colitis. Severe colitis noted during colonoscopy is shown in the image below. Severe colitis noted during colonoscopy. The mucosSevere colitis noted during colonoscopy. The mucosa is grossly denuded, with active bleeding noted. This patient had her colon resected very shortly after this view was obtained.
  • Upper endoscopy with small-intestinal biopsies is recommended in patients in whom peptic ulcer disease, Helicobacter pylori infection, Crohn disease, celiac disease, or other malabsorption conditions are suspected.
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Contributor Information and Disclosures
Author

Mohammad F El-Baba, MD  Assistant Professor of Pediatrics, Division of Pediatric Gastroenterology, Wayne State University School of Medicine; Division Chief of Pediatric Gastroenterology, Children's Hospital of Michigan

Mohammad F El-Baba, MD is a member of the following medical societies: American Gastroenterological Association and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Specialty Editor Board

Hisham Nazer, MB, BCh, FRCP, DCh, DTM&H  Professor of Pediatrics, Consultant in Pediatric Gastroenterology, Hepatology and Clinical Nutrition, Bushnaq Medical Centre, University of Jordan Faculty of Medicine, Jordan

Hisham Nazer, MB, BCh, FRCP, DCh, DTM&H is a member of the following medical societies: Royal College of Paediatrics and Child Health, Royal College of Physicians, Royal College of Surgeons in Ireland, Royal College of Surgeons of Edinburgh, and Royal Society of Tropical Medicine and Hygiene

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David A Piccoli, MD  Chief of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia; Professor, University of Pennsylvania School of Medicine

David A Piccoli, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

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Severe colitis noted during colonoscopy. The mucosa is grossly denuded, with active bleeding noted. This patient had her colon resected very shortly after this view was obtained.
 
 
 
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