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Clinical:Irritable Bowel Syndrome
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Etiology
Irritable bowel may also be the cause of symptoms among patients who have diverticular disease.[1]
Prevalence
The prevalence of irritable bowel syndrome among patients suspected of irritable bowel in primary care, if diverticular disease or polyps are considered coincidental and not mutually exclusive to irritable bowel syndrome, is 87%.[2]
Diagnosis
| Likelihood ratio + | Likelihood ratio - | |
|---|---|---|
| History alone (Manning criteria) | 2.9 | 0.29 |
| History and physical examination (Rome criteria) | 4.8 | 0.34 |
| History, physical examination, and laboratory tests (Kruis score) | 8.6 | 0.26 |
History, physical examination, and laboratory tests combined (Kruis Score)
A meta-analysis by the Rational Clinical Examination concluded regarding the Kruis score:[3]
- Likelihood ratio + 8.6
- Likelihood ratio - 0.26
| Finding | Score |
| Abdominal pain, flatulence, or bowel irregularity | 34 |
| Duration of symptoms >2 y | 16 |
| Abdominal pain is "burning, cutting, very strong, terrible, feeling of pressure, dull, boring, not so bad" | 23 |
| Alternating constipation and diarrhea | 14 |
| History of blood in stool | -98 |
| Physical examination or history pathognomonic for an alternative diagnosis | -47 |
| ESR > 10 mm/hr | -13 |
| WBC > 10k | -50 |
| Hemoglobin < 12 g/dL for females or < 14 g/dL for males | -98 |
Treatment
Fiber
Soluble fiber (psyllium or also called ispaghula husk) is more effective than insoluble fiber (bran).[4]
References
- ↑ Otte, J J, and L Larsen, and J R Andersen. "Irritable bowel syndrome and symptomatic diverticular disease--different diseases?" The American journal of gastroenterology 81 (1986): 529-31 - Abstract
- ↑ Bellentani, S et. al. "A simple score for the identification of patients at high risk of organic diseases of the colon in the family doctor consulting room. The Local IBS Study Group." Family practice 7 (1990): 307-12 - Abstract
- ↑ Ford, Alexander C et. al. "Will the history and physical examination help establish that irritable bowel syndrome is causing this patient's lower gastrointestinal tract symptoms?" JAMA : the journal of the American Medical Association 300 (2008): 1793-805 - Abstract
- ↑ Bijkerk, C J et. al. "Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial." BMJ (Clinical research ed.) 339 (2009): b3154 - Abstract
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