Irritable Bowel Syndrome Differential Diagnoses

Updated: Feb 07, 2018
  • Author: Jenifer K Lehrer, MD; Chief Editor: BS Anand, MD  more...
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Diagnostic Considerations

Manning and associates established 6 criteria to distinguish irritable bowel syndrome from organic bowel disease. [20] 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
  • Food intolerances, including lactose, fructose, and FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols)

Differential Diagnoses