Irritable Bowel Syndrome MCQs

Irritable bowel syndrome is a clinical diagnosis characterized by- Abdominal pain relieved by defecation Bloating Alternating bowel habits - constipation, diarrhoea - alone or alternating with each other. Reference: Harrison's Principles of Internal Medicine, 21 st Ed, Ch: 327 pg: 2490

The 'red flag' indicators listed in the NICE guidelines as: Unintentional and unintended weight loss Rectal bleeding A family history of bowel or ovarian cancer A change in bowel habit to loose and / or more frequent stools persisting for more than six weeks in a person aged over 60 years. Also, on clinical examination the other 'red flag' indicators are: Anaemia Abdominal mass Rectal mass Inflammatory markers for inflammatory bowel disease. Reference: Harrison's Principles of Internal Medicine 21 st Ed, Ch: 327 Pg: 2493

Irritable bowel syndrome is a functional bowel disorder which is non inflammatory. The unifying feature of inflammatory diarrhea due to any cause is the presence of leukocytes or leukocyte derived protein Calprotectin in stools. Another inflammatory marker in stool is Fecal Lactoferrin, which is also present in activated neutrophils. Both of them can be used in diagnosis of relapses of inflammatory bowel disease from IBS or bacterial overgrowth. Fecal calprotectin is also having the advantage of being a sensitive marker of Colonic or ileocolonic inflammation rather than isolated ileal inflammation. Abdominal pain, diarrhea and presence of mucous in stools can be seen in IBS as well as inflammatory diarrhea. Blood in stools, nocturnal symptoms and weight loss is uncommon in IBS.