Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2008 Apr 17;358(16):1692-9.
doi: 10.1056/NEJMcp0801447.

Clinical practice. Irritable bowel syndrome

Emeran A Mayer  1
Affiliations
Review

Clinical practice. Irritable bowel syndrome

Emeran A Mayer. N Engl J Med. .

Abstract

A 28-year-old woman presents with a 7-month history of recurrent, crampy pain in the left lower abdominal quadrant, bloating with abdominal distention, and frequent, loose stools. She reports having had similar but milder symptoms since childhood. She spends long times in the bathroom because she is worried about uncontrollable discomfort and fecal soiling if she does not completely empty her bowels before leaving the house. She feels anxious and fatigued and is frustrated that her previous physician did not seem to take her distress seriously. Physical examination is unremarkable except for tenderness over the left lower quadrant. How should her case be evaluated and treated?

PubMed Disclaimer

Conflict of interest statement

No other potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1. Differential Diagnosis
Testing for celiac sprue may be useful in patients who meet the Rome criteria (especially in those with diarrheapredominant IBS), in patients who have warning signs, and in populations in which the prevalence of celiac sprue is high. If there are no warning signs, then basic blood counts, serum biochemical studies, stool testing for occult blood and ova and parasites, and measurement of thyrotropin levels are indicated only if there is a supportive clinical history. Colonoscopy is recommended only in patients who have warning signs. However, according to screening guidelines for colon cancer, routine colonoscopy should be performed in patients at the age of 50 years or older, regardless of whether IBS symptoms are present. If there has been a major qualitative change in the pattern of chronic symptoms, a new coexisting condition should be suspected, and a more comprehensive diagnostic approach is warranted.
See this image and copyright information in PMC

References

    1. Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:2108–2131. - PubMed
    1. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. In: Drossman DA, Corazziari E, Delvaux M, et al., editors. Rome III: the functional gastrointestinal disorders. 3rd ed. McLean, VA: Degnon; 2006. pp. 487–555.
    1. Halder SL, Locke GR, III, Schleck CD, Zinsmeister AR, Melton LJ, III, Talley NJ. Natural history of functional gastrointestinal disorders: a 12-year longitudinal population-based study. Gastroenterology. 2007;133:799–807. - PubMed
    1. Whitehead WE, Palsson O, Jones KR. Systemic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:1140–1156. - PubMed
    1. Wessely S, White PD. There is only one functional somatic syndrome. Br J Psychiatry. 2004;185:95–96. - PubMed

Publication types

MeSH terms