EVALUATION OF IRRITABLE BOWEL SYNDROME USING ‘EXCLUSION CRITERIA’

Abstract

Aims To estimate the occurrence of IBS in patients who were evaluated for organic bowel problems in a tertiary care university hospital.Methods Seven hundred and seventy case records were retrieved from the medical records department who were evaluated for organic bowel problems. Data were fed into forms especially designed fulfilling the Manning and Rome 11 criteria for the diagnosis of IBS. Patients under went through history and physical along with comprehensive laboratory evaluation including CBC, ESR, LFTs, BUN, Creatinine, Electrolytes, Stool detailed report, Abdominal Ultrasound, Pelvic Ultrasound in females where indicated, Flexible sigmoidoscopy and or full colonoscopy, upper GI endoscopy, CT scan of the abdomen where indicated. ERCP was also performed in evaluation of cases in special circumstances.Results Seventy‐six patients (9.87%) fulfilled the diagnostic criteria for Irritable bowel syndrome. Abdominal pain was present in 75% of the cases, lower abdomen was the most frequent site in 68% of cases, and epigastric discomfort or pain was seen in 30%. Character of the pain was spasmodic in 50% of cases and the radiation was mostly to either side into the flanks. Pain and bloating were aggravated post–prandially. There was no special relationship to the type of food. Passage of flatus relieved bloating and pain in 30% of cases. Gas distribution was towards head in 8% and chest in 4% of cases. Stools were loose in 68% and hard, lumpy or straw shaped in the rest. Frequency of stooling was as low as 2/week to 10/day. Abdominal examination revealed epigastric tenderness in 14.7% and lower abdominal tenderness was found in 27.63%. Hemoglobin was normal in all except in 2 cases, which was due to excessive menstrual losses. ESR, LFTs, Bun, Creatinine, Electrolytes were normal in all cases. Stool detailed report was essentially normal in all, except cysts of Blastocystis Hominis were seen in 14% of cases. Flexible Sigmoidoscopy/and or Colonoscopy were normal in all cases except the presence of Hemorrhoids in 9%. Rectal biopsy was also normal in all cases. EGD revealed antral gastritis in 50% patients, which was positive for Helicobacter pylori in 62%. Anxiety and depression were significant in 28.9% of cases.Conclusions This study confirms that IBS is a common occurrence in a tertiary care Gastroenterology Center where mostly exclusion criteria is used for the diagnosis of IBS. This is to emphasize that the symptomatology of IBS is fairly consistent and characteristic and should be given weightage for the diagnosis of IBS. Exclusion criteria should be reserved for more difficult cases especially with the alarm symptoms.