Diagnostic Considerations

Manning and associates established 6 criteria to distinguish irritable bowel syndrome from organic bowel disease.^[29]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

Abdominal Angina
Acute Cholecystitis and Biliary Colic
Acute Intermittent Porphyria
Anxiety Disorders
Bacterial Gastroenteritis
Bacterial Overgrowth Syndrome
Biliary Disease
Celiac Disease (Sprue)
Chronic Mesenteric Ischemia
Chronic Pancreatitis
Microscopic Colitis (Collagenous and Lymphocytic Colitis)
Colon Cancer
Emergent Management of Lead Toxicity
Endometriosis
Food Allergies
Giardiasis
Hypercalcemia
Hyperthyroidism and Thyrotoxicosis
Hypothyroidism
Inflammatory Bowel Disease
Lactose Intolerance
Malignant Neoplasms of the Small Intestine
Mesenteric Artery Thrombosis
Mesenteric Venous Thrombosis
Pancreatic Cancer
Pheochromocytoma
Postcholecystectomy Syndrome
Somatostatinomas
Ulcerative Colitis
Viral Gastroenteritis

Workup

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Media Gallery

Irritable Bowel Syndrome (IBS). What is IBS? IBS is a condition that involves recurrent abdominal pain as well as abnormal bowel motility, which can include diarrhea and/or constipation.

of 1

Author

Jenifer K Lehrer, MD Attending Physician, Department of Gastroenterology, Jefferson Health System Torresdale Campus, Philadelphia

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

Disclosure: Nothing to disclose.

Coauthor(s)

Gary R Lichtenstein, MD Professor of Medicine, Director, Center for Inflammatory Bowel Disease, Department of Medicine, Division of Gastroenterology, Perelman School of Medicine at the 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, American Society for Gastrointestinal Endoscopy

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Abbott Corp/Abbvie; Actavis; Alaven; CellCeutrix; Celgene; Ferring; Gilead; Hospira; Janssen Orthobiotech; Luitpold/American Regent; Pfizer Pharm; Prometheus Labs; Romark; Salix Pharma/Valeant; Santarus/Receptos/Celgene; Shire Pharma; Takeda; UCB<br/>Received research grant from: Salix Pharm/Valeant; Santarus/Receptos/Celgene; Shire Pharm; UCB<br/>Received author or editor honorarium or book royalty from for: Clinical Advances in Gastroenterology; Gastroenterology and Hepatology; Gastro-Hep Communications; Ironwood; Luitpold/American Regent; Merck; McMahon Publishing; Romark; SLACK Inc; Springer Science and Business Media; Up-To-Date.

Specialty Editor Board

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.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

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

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

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