Clinical manifestations and diagnosis of irritable bowel syndrome in adults
- Arnold Wald, MD
Arnold Wald, MD
- Professor of Medicine
- University of Wisconsin School of Medicine and Public Health, Madison
Irritable bowel syndrome (IBS) is a gastrointestinal syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause. It is the most commonly diagnosed gastrointestinal condition. The prevalence of IBS in North America estimated from population-based studies is approximately 10 to 15 percent [1-6]. A population-based study in Europe found an overall prevalence of 11.5 percent (a value similar to that noted in reports in the United States); however, the prevalence varied widely among countries .
IBS affects men and women, young patients, and older adults. However, younger patients and women are more likely to be diagnosed with IBS . A systematic review estimated that there is an overall 2:1 female predominance in North America .
Only about 15 percent of those affected actually seek medical attention [1,2,9-11]. Nevertheless, the absolute number of patients is still so large that IBS in its various forms comprises 25 to 50 percent of all referrals to gastroenterologists . IBS also accounts for a significant number of visits to primary care physicians, and is the second highest cause of work absenteeism after the common cold . IBS has been associated with increased health care costs, with some studies suggesting annual direct and indirect costs of up to $30 billion .
This topic review will discuss the clinical manifestations and diagnosis of IBS. The pathophysiology and therapy of this disorder are presented separately. (See "Pathophysiology of irritable bowel syndrome" and "Treatment of irritable bowel syndrome in adults".)
Patients with irritable bowel syndrome (IBS) can present with a wide array of symptoms which include both gastrointestinal and extraintestinal complaints. However, the symptom complex of chronic abdominal pain and altered bowel habits remains the nonspecific yet primary characteristic of IBS .
- Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ 3rd. Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology 1991; 101:927.
- Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993; 38:1569.
- American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009; 104 Suppl 1:S1.
- Hahn BA, Saunders WB, Maier WC. Differences between individuals with self-reported irritable bowel syndrome (IBS) and IBS-like symptoms. Dig Dis Sci 1997; 42:2585.
- Saito YA, Locke GR, Talley NJ, et al. A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome. Am J Gastroenterol 2000; 95:2816.
- Thompson WG, Irvine EJ, Pare P, et al. Functional gastrointestinal disorders in Canada: first population-based survey using Rome II criteria with suggestions for improving the questionnaire. Dig Dis Sci 2002; 47:225.
- Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Aliment Pharmacol Ther 2003; 17:643.
- Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10:712.
- Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ 1992; 304:87.
- Heaton KW, O'Donnell LJ, Braddon FE, et al. Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters. Gastroenterology 1992; 102:1962.
- Ford AC, Forman D, Bailey AG, et al. Irritable bowel syndrome: a 10-yr natural history of symptoms and factors that influence consultation behavior. Am J Gastroenterol 2008; 103:1229.
- Everhart JE, Renault PF. Irritable bowel syndrome in office-based practice in the United States. Gastroenterology 1991; 100:998.
- Schuster MM. Diagnostic evaluation of the irritable bowel syndrome. Gastroenterol Clin North Am 1991; 20:269.
- Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology 2002; 122:1500.
- Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology 2006; 130:1480.
- Swarbrick ET, Hegarty JE, Bat L, et al. Site of pain from the irritable bowel. Lancet 1980; 2:443.
- Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J 1978; 2:653.
- Lovell RM, Ford AC. Prevalence of gastro-esophageal reflux-type symptoms in individuals with irritable bowel syndrome in the community: a meta-analysis. Am J Gastroenterol 2012; 107:1793.
- Whorwell PJ, McCallum M, Creed FH, Roberts CT. Non-colonic features of irritable bowel syndrome. Gut 1986; 27:37.
- Hershfield NB. Nongastrointestinal symptoms of irritable bowel syndrome: an office-based clinical survey. Can J Gastroenterol 2005; 19:231.
- Talley NJ, Phillips SF, Melton LJ, et al. Diagnostic value of the Manning criteria in irritable bowel syndrome. Gut 1990; 31:77.
- Smith RC, Greenbaum DS, Vancouver JB, et al. Gender differences in Manning criteria in the irritable bowel syndrome. Gastroenterology 1991; 100:591.
- Taub E, Cuevas JL, Cook EW 3rd, et al. Irritable bowel syndrome defined by factor analysis. Gender and race comparisons. Dig Dis Sci 1995; 40:2647.
- Mearin F, Lacy BE, Chang L, et al. Bowel Disorders. Gastroenterology 2016.
- Hammer J, Talley NJ. Diagnostic criteria for the irritable bowel syndrome. Am J Med 1999; 107:5S.
- Fass R, Longstreth GF, Pimentel M, et al. Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome. Arch Intern Med 2001; 161:2081.
- Vanner SJ, Depew WT, Paterson WG, et al. Predictive value of the Rome criteria for diagnosing the irritable bowel syndrome. Am J Gastroenterol 1999; 94:2912.
- Ford AC, Bercik P, Morgan DG, et al. Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gastroenterology 2013; 145:1262.
- Camilleri M, Choi MG. Review article: irritable bowel syndrome. Aliment Pharmacol Ther 1997; 11:3.
- Kruis W, Thieme C, Weinzierl M, et al. A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease. Gastroenterology 1984; 87:1.
- Frigerio G, Beretta A, Orsenigo G, et al. Irritable bowel syndrome. Still far from a positive diagnosis. Dig Dis Sci 1992; 37:164.
- American Gastroenterology Association. American Gastroenterological Association medical position statement: irritable bowel syndrome. Gastroenterology 2002; 123:2105.
- O'Connor OJ, McSweeney SE, McWilliams S, et al. Role of radiologic imaging in irritable bowel syndrome: evidence-based review. Radiology 2012; 262:485.
- Schmulson MW, Chang L. Diagnostic approach to the patient with irritable bowel syndrome. Am J Med 1999; 107:20S.
- Svendsen JH, Munck LK, Andersen JR. Irritable bowel syndrome--prognosis and diagnostic safety. A 5-year follow-up study. Scand J Gastroenterol 1985; 20:415.
- Ford AC, Chey WD, Talley NJ, et al. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch Intern Med 2009; 169:651.
- Cash BD, Rubenstein JH, Young PE, et al. The prevalence of celiac disease among patients with nonconstipated irritable bowel syndrome is similar to controls. Gastroenterology 2011; 141:1187.
- Guagnozzi D, Arias Á, Lucendo AJ. Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders. Aliment Pharmacol Ther 2016; 43:851.
- Kamp EJ, Kane JS, Ford AC. Irritable Bowel Syndrome and Microscopic Colitis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2016; 14:659.
- Gudsoorkar VS, Quigley EM. Distinguishing Microscopic Colitis From Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2016; 14:669.
- Katon WJ, Von Korff M, Lin E. Panic disorder: relationship to high medical utilization. Am J Med 1992; 92:7S.
- Drossman DA, Thompson WG. The irritable bowel syndrome: review and a graduated multicomponent treatment approach. Ann Intern Med 1992; 116:1009.
- Drossman DA, Talley NJ, Leserman J, et al. Sexual and physical abuse and gastrointestinal illness. Review and recommendations. Ann Intern Med 1995; 123:782.
- CLINICAL MANIFESTATIONS
- Chronic abdominal pain
- Altered bowel habits
- - Diarrhea
- - Constipation
- Other gastrointestinal symptoms
- Extraintestinal symptoms
- DIAGNOSTIC CRITERIA
- DIAGNOSTIC APPROACH
- Diarrhea-predominant IBS
- Constipation-predominant IBS
- Mixed IBS
- Refractory symptoms
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS