Irritable Bowel Syndrome (IBS) - Diagnosis and Workup Summary
Use a positive diagnostic strategy with minimal testing.  IBS is NOT a diagnosis of exclusion.
Rome IV Criteria - Recurrent abdominal pain ~ ≥ 1x/ week in last 3 months + symptom onset ≥ 6 months associated with ≥ 2 of the following:
  1. Related to defecation
  2. Change in frequency of stool
  3. Change in form of stool
  * Bloating not required for diagnosis
No Need For:
 • Routine stool cultures, but test for Giardia in those at high risk
 • Routine colonoscopy in <45 yo w/o red flags - Low chance of "missing things" →  fewer polyps in IBS vs non-IBS!
 • Food allergy/ sensitivity testing unless reproducible reactions
Don't Forget to Rule Out These Things!
 • If Diarrhea:
    - Rule out celiac disease w/ T TG IgA & IgA or 6 biopsies from duodenum (including bulb)
    - Rule out inflammatory bowel disease w/ fecal calprotectin or fecal lactoferrin + CRP
 • If ?Pelvic Floor Disorder &/or Refractory Constipation - Diagnose dyssynergic defecation w/ 2 of 3:
    - Anorectal manometry (ARM)
    - Balloon Expulsion Test (BET)
    - Defecography

by Tina Hang, MD @TinaPhamHang via Emory Gastroenterology and Hepatology @EmoryGastroHep

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