Information on IBS, Irritable Bowel Syndrome and IBS Treatment - Dirk Budka
 
 
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Gastroenterology


IBS DIAGNOSIS IS A LONG EXCLUSION LIST...
...BECAUSE THERE IS NO CLEAR DIAGNOSIS, ALL OTHER DISEASES/POSSIBILITES HAVE TO BE EXCLUDED, WHICH MAKES A FINAL IBS-DIAGNOSIS EXTREMELY DIFFICULT.


When symptoms occur, worsen or are constant over a long period of time, the sufferers decide to see their doctor, who will – after first examinations - refer the patient to a gastrointestinal specialist. All tests are designed to be very effective in detecting cancers in their very early stages.

Statistically it takes up to 1.5 years, before a sufferer decides to seek help. Another 0.7 years have to be added for a final diagnosis. This long period of time shows that viruses or parasites as 'culprit' for IBS related symptoms is very doubtful.

There are two forms of IBS: a) Lower Abdominal Pain IBS and b) Non-ulcer Dyspepsia. The abdominal pain IBS is either prescribed as
diarrhoea predominant IBS-D
constipation predominant IBS-C
IBS with alternating stool pattern IBS-A
Postinfectious IBS IBS-PI

After some blood tests, the GP will refer the patient to a gastroenterologist for the following (available) tests:


- Sigmoidoscopy (inspection of the lower colon): A flexible sigmoidoscope (approx. 60cm long) provides a very good visualisation with minimal discomfort for the patient.
- Colonoscopy (inspection of the entire colon): A more common and more detailed examination.
- EGD (Oesophagogastroduodenoscopy)
- Abdominal ultrasound or CTscan
- Blood test (full blood count, liver enzymes, electrolytes, renal function, erythrocyte sedimention rate)
- Stool chemistry** (test for exocrine pancreas electrolytes, microbiology, faecal fat, malabsorption problems
- Blood test or deep duodenal biopsy for Celiac Disease
- For women, a gynaecological exam including CA-125 blood test for ovarian cancer


Why these tests?

# to evaluate blood in the stool

# to determine the type and the extent of the INFLAMMATORY BOWEL DISEASE (Ulcerative Colitis or Crohn’s Disease)

# to evaluate persistent diarrhoea and/or abdominal pain

# to obtain tissue specimen for biopsy

# to evaluate anaemia

# to evaluate previous findings of polyps

# to check for colon cancer (especially in patients with a family history in colon cancer)

Abnormal results:


# gastrointestinal bleedings

# Inflammatory Bowel Disease (IBD)

# diverticulosis

# tumour

# colorectal polyps (in most cases removed during the test)

# parasites*

# for patients with numbness and constipation, Multiple Sclerosis may need to be excluded

# for older patients (age 50 and above), pancreatic cancer may need to
be excluded.


* Parasites are NO IBS-criteria; they do not cause IBS, but completely different diseases. The longer a patient suffers from IBS or IBS related symptoms the more implausible is the parasite theory.
** Concerning the CDSA (Comprehensive Digestive Stool Analysis) the jury is still out... but there are more and more doubts. For microbiologic tests the stool sample is collected by a rectal swab and is analysed wihin 60 minutes of taking the sample.
Stool test accuracy using just microscopy is low. Not just because of the use of preparation medication (antacids, antidiarrheal medication, enemas, laxatives, antibiotics... and an exclusion diet several days before the test. Stool samples contaminated with urine, menstrual blood or bleeding haemorrhoids may interfere with results.
What you can check is a high level of fat in the stool (might indicate chronic pancreatitis, cystic fibrosis or celiac disease), a pH level higher than 6.8 indicates malabsorption problems and below 5.3 a poor sugar absorption. Low levels of trypsin or elastase enzymes may indicate digestive complication of the pancreas. The presence of white blood cells in the stool may indicate bacterial diarrhoea (again bacteria are NO parasites).

A test using PCR (Polymerase Chain Reaction) especially when looking for one or more specific pathogens is very accurate. Our MSML lab is using PCR.