Rational investigations in irritable bowel syndrome

Frontline Gastroenterology
Christopher J Black, Alexander C Ford

Abstract

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder which accounts for a substantial proportion of a gastroenterologist's time in the outpatient clinic. However, there is variability in approaches to diagnosis and investigation between physicians, dependent on expertise. Many patients express disappointment over the lack of a patient-centred approach. Consequently, there have been calls for the care of patients with IBS to be standardised, a process which aims to promote high-quality and high-value care. Making an early diagnosis, based on a clinical assessment of symptoms, while limiting use of investigations, are key tenets of this process. Exhaustive investigation to exclude all organic pathology is unnecessary, and may be counterproductive. Routine blood tests in suspected IBS have low yield, but are an acceptable part of routine practice. All patients should have coeliac serology tested, regardless of their predominant stool form. Patients with diarrhoea should have a faecal calprotectin measured, and should proceed to colonoscopy to exclude inflammatory bowel disease (IBD) if this is positive. Beyond this, the need for investigations should be made on a case-by-case basis, contingent on the rep...Continue Reading

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Citations

Apr 17, 2020·Nature Reviews. Gastroenterology & Hepatology·Christopher J Black, Alexander C Ford
Mar 9, 2021·Frontiers in Pharmacology·Esther ColomierChloé Melchior
Apr 10, 2021·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·Ayodele Sasegbon, Dipesh H Vasant
May 28, 2020·Frontline Gastroenterology·Christopher J Black, Alexander Charles Ford

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