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shawn12
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Date Joined Jul 2004
Total Posts : 1293
   Posted 9/14/2010 1:04 PM (GMT -7)   
I would like to do a thread on IBS 101, diagnosing IBS and what it actually is to begin with that can really help people.
 
First
 
An interview with Douglas A. Drossman, MD, Co-Director, UNC Center for Functional GI & Motility Disorders, University of North Carolina, Chapel Hill, NC. Dr. Drossman is a clinician, a clinical researcher, and an educator. In this video, Dr. Drossman explains continuing advances that help us understand and visualize these conditions.
http://www.youtube.com/watch?v=bm3gboLimvw
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 9/16/2010 11:03 AM (GMT -7)   

with permission from Jackson Gastroenterology.

Irritable Bowel Syndrome


What is an Irritable Bowel?
Medically, irritable bowel syndrome (IBS) is known by a variety of other terms: spastic colon, spastic colitis, mucous colitis and nervous or functional bowel. Usually, it is a disorder of the large intestine (colon), although other parts of the intestinal tract -- even up to the stomach -- can be affected.

The colon, the last five feet of the intestine, serves two functions in the body. First, it dehydrates and stores the stool so that, normally, a well-formed soft stool occurs. Second, it quietly propels the stool from the right side over to the rectum, storing it there until it can be evacuated. This movement occurs by rhythmic contractions of the colon.

When IBS occurs, the colon does not contract normally. instead, it seems to contract in a disorganized, at times violent, manner. The contractions may be terribly exaggerated and sustained, lasting for prolonged periods of time. One area of the colon may contract with no regard to another. At other times, there may be little bowel activity at all. These abnormal contractions result in changing bowel patterns with constipation being most common.

A second major feature of IBS is abdominal discomfort or pain. This may move around the abdomen rather than remain localized in one area.

These disorganized, exaggerated and painful contractions lead to certain problems. The pattern of bowel movements is often altered. Diarrhea may occur, especially after meals, as the entire colon contracts and moves liquid stool quickly into the rectum. Or, localized areas of the colon may remain contracted for a prolonged time. When this occurs, which often happens in the section of colon just above the rectum, the stool may be retained for a prolonged period and be squeezed into small pellets. Excessive water is removed from the stool and it becomes hard.

Also, air may accumulate behind these localized contractions, causing the bowel to swell. So bloating and abdominal distress may occur.

Some patients see gobs of mucous in the stool and become concerned. Mucous is a normal secretion of the bowel, although most of the time it cannot be seen. IBS patients sometimes produce large amounts of mucous, but this is not a serious problem.

The cause of most IBS symptoms -- diarrhea, constipation, bloating, and abdominal pain -- are due to this abnormal physiology.

IBS is not a disease
Although the symptoms of IBS may be severe, the disorder itself is not a serious one. There is no actual disease present in the colon. In fact, an operation performed on the abdomen would reveal a perfectly normal appearing bowel.

Rather, it is a problem of abnormal function. The condition usually begins in young people, usually below 40 and often in the teens. The symptoms may wax and wane, being particularly severe at some times and absent at others. Over the years, the symptoms tend to become less intense.

IBS is extremely common and is present in perhaps half the patients that see a specialist in gastroenterology. It tends to run in families. The disorder does not lead to cancer. Prolonged contractions of the colon, however, may lead to diverticulosis, a disorder in which balloon-like pockets push out from the bowel wall because of excessive, prolonged contractions.

Causes
While our knowledge is still incomplete about the function and malfunction of the large bowel, some facts are well-known. Certain foods, such as coffee, alcohol, spices, raw fruits, vegetables, and even milk, can cause the colon to malfunction. In these instances avoidance of these substances is the simplest treatment.

Infections, illnesses and even changes in the weather somehow can be associated with a flare-up in symptoms. So can the premenstrual cycle in the female.

By far, the most common factor associated with the symptoms of IBS are the interactions between the brain and the gut. The bowel has a rich supply of nerves that are in communication with the brain. Virtually everyone has had, at one time or another, some alteration in bowel function when under intense stress, such as before an important athletic event, school examination, or a family conflict.

People with IBS seem to have an overly sensitive bowel, and perhaps a super abundance of nerve impulses flowing to the gut, so that the ordinary stresses and strains of living somehow result in colon malfunction.

These exaggerated contractions can be demonstrated experimentally by placing pressure- sensing devices in the colon. Even at rest, with no obvious stress, the pressures tend to be higher than normal. With the routine interactions of daily living, these pressures tend to rise dramatically. When an emotionally charged situation is discussed, they can reach extreme levels not attained in people without IBS. These symptoms are due to real physiologic changes in the gut -- a gut that tends to be inherently overly sensitive, and one that overreacts to the stresses and strains of ordinary living.

Diagnosis
The diagnosis of IBS often can be suspected just by a review of the patient's medical history. In the end it is a diagnosis of exclusion; that is, other conditions of the bowel need to be ruled out before a firm diagnosis of IBS can be made.

A number of diseases of the gut, such as inflammation, cancer, and infection, can mimic some or all of the IBS symptoms. Certain medical tests are helpful in making this diagnosis, including blood, urine and stool exams, x-rays of the intestinal tract and a lighted tube exam of the lower intestine. This exam is called endoscopy, sigmoidoscopy or colonoscopy.

Additional tests often are required depending on the specific circumstances in each case. If the proper medical history is obtained and if other diseases are ruled out, a firm diagnosis of IBS then can usually be made.

Treatment
The treatment of IBS is directed to both the gut and the psyche. The diet requires review, with those foods that aggravate symptoms being avoided.

Current medical thinking about diet has changed a great deal in recent years. There is good evidence to suggest that, where tolerated, a high roughage and bran diet is helpful. This diet can result in larger, softer stools which seem to reduce the pressures generated in the colon.

Large amounts of beneficial fiber can be obtained by taking over-the-counter bulking agents such as psyllium mucilloid (Metamucil, Konsyl) or methylcellulose (Citrucel).

As many people have already discovered, the simple act of eating may, at times, activate the colon. This action is a normal reflex, although in IBS patients it tends to be exaggerated. It is sometimes helpful to eat smaller, more frequent meals to block this reflex.

There are certain medications that help the colon by relaxing the muscles in the wall of the colon, thereby reducing the bowel pressure. These drugs are called antispasmodics. Since stress and anxiety may play a role in these symptoms, it can at times be helpful to use a mild sedative, often in combination with an antispasmodic.

Physical exercise, too, is helpful. During exercise, the bowel typically quiets down. If exercise is used regularly and if physical fitness or conditioning develops, the bowel may tend to relax even during non-exercise periods. The invigorating effects of conditioning, of course, extend far beyond the intestine and can be recommended for general health maintenance.

As important as anything else in controlling IBS is learning stress reduction, or at least how to control the body's response to stress. It certainly is well-known that the brain can exert controlling effects over many organs in the body, including the intestine.

Summary
Patients with IBS can be assured that nothing serious is wrong with the bowel. Prevention and treatment may involve a simple change in certain daily habits, reduction of stressful situations, eating better and exercising regularly.

Perhaps the most important aspect of treatment is reassurance. For most patients, just knowing that there is nothing seriously wrong is the best treatment of all, especially if they can learn to deal with their symptoms on their own.

http://www.gicare.com/pated/ecdgs03.htm

 

 


IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 9/18/2010 11:55 AM (GMT -7)   
somethings have changed since the above was written years ago.

IBS is no longer a "diagnoses of exclusion" There are guidelines -Rome Criteria- to make an accurate IBS diagnoses, based on "specific" "clusterings of symptoms." minus red flags symptoms.

The connections between the bowel and gut have been confirmed.

Abnormalities have been found.

Fiber may help some and not others.
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 9/22/2010 9:35 AM (GMT -7)   
Diagnosing functional gastrointestinal disorders

There is growing recognition of the seriousness and the complexity of the functional GI disorders. Yet individuals affected by these disorders still face challenges in finding adequate care. Many physicians remain unprepared to diagnose and treat patients with functional GI disorders. Most doctors are trained to diagnose and treat conditions that they can see on examination or test. Functional GI disorders are different. This can lead to a negative or confusing patient-doctor interaction. How can this be overcome to result in a positive, practical interaction? In this video Brennan M.R. Spiegel, MD comments. Dr. Spiegel is Assistant Professor of Medicine in Residence, David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, Division of Internal Medicine, Department of Gastroenterology and Hepatology, Los Angeles, CA.

http://www.youtube.com/watch?v=9vyVpEQw1ek
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 9/22/2010 9:43 AM (GMT -7)   
Leading GI specialist and psychiatrist, Dr. Douglas A. Drossman, explains how Irritable Bowel Syndrome is diagnosed.

http://www.webmd.com/video/drossman-how-ibs-diagnosed


about the Rome Foundation


The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of functional gastrointestinal disorders (FGIDs). Our mission is to improve the lives of people with functional GI disorders.

Over the last 17 years, the Rome organization has sought to legitimize and update our knowledge of the FGIDs. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of gastrointestinal function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice.

The Rome Foundation is committed to the continuous development, legitimization and preservation of the field of FGIDs through science-based activities. We are inclusive and collaborative, patient-centered, innovative and open to new ideas.



The Mission of the Rome Foundation
To improve the lives of people with Functional GI Disorders



The goals of the Rome Foundation are to:

Promote clinical recognition and legitimization of FGIDs
Develop a scientific understanding of their pathophysiological mechanisms
Optimize clinical management for patients with FGIDs

http://romecriteria.org/about/

The different functional GI conditions and the parts of the body they effect and how to diagnose them.


http://romecriteria.org/rome_III_gastro/
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 9/22/2010 10:02 AM (GMT -7)   
Symptoms of IBS

http://www.aboutibs.org/site/about-ibs/symptoms/

Recognizing Symptoms

http://www.aboutibs.org/site/about-ibs/symptoms/recognizing-symptoms

Diagnosis of IBS

http://www.aboutibs.org/site/about-ibs/symptoms/diagnosis


The Clinical Presentation of IBS

The diagnosis of IBS is determined by certain symptom clusters that "breed true" as a distinct clinical entity. The evidence for and features of these specific symptoms are discussed below.

Presentation of Symptoms
The most frequently reported symptom in IBS is pain or discomfort in the abdomen.[9,10] This pain often is poorly localized and may be migratory or variable in nature, and is usually relieved with defecation, thus supporting a primary colonic origin for this symptom. It is also associated with a change in the consistency or frequency of stools and with altered bowel habits (ie, diarrhea, constipation, or combination of both at varying times).[3,11,12] Other symptoms -- including bloating, urgency, or the feeling of incomplete evacuation -- are present frequently, again suggesting colonic dysfunction.

Although IBS symptoms often occur in clusters[13]; some of the symptoms may occur sequentially and may vary in kind, location, and severity over time.[9] The frequency of IBS episodes also varies greatly among patients. While some patients may have daily episodes or continuous symptoms, others experience long symptom-free periods.[9] These patterns raise the question as to when someone has IBS as opposed to occasional bowel complaints that may be considered a part of the normal response of the bowel to stress.[14] For the most part, the characterization of IBS as a "disorder" is determined by certain frequency guidelines developed from epidemiologic and clinical studies.

A subgroup of patients with IBS also complain about other (ie, noncolonic) gastrointestinal (GI) symptoms, such as heartburn, nausea, and early satiety. Furthermore, significant overlap has been reported between IBS and other functional GI disorders (eg, functional dyspepsia, functional heartburn, proctalgia fugax),[15-18] with, as mentioned earlier, an individual's primary symptoms shifting over time.[17] Patients with IBS have other (ie, non-GI) symptoms and therefore visit their primary care physician quite often for both GI and non-GI complaints.[2,19] The non-GI symptoms include fibromyalgia[20-23] and other musculoskeletal symptoms,[20] headache, genitourinary symptoms,[24] sexual dysfunction,[25] sleep disturbances,[26,27] and chronic fatigue.

These findings are consistent with IBS involving dysfunction of both the central and peripheral nervous system (ie, a "brain-gut disorder"). There may be a peripheral (ie, visceral) basis for some GI symptoms due to dysfunction of the enteric nervous system in the upper as well as the lower gut. In addition, and particularly for patients with higher levels of psychosocial distress or psychological comorbidity, there may be central upregulation of peripheral (both somatic or visceral) signals based on central nervous system (CNS) hypervigilance or hypersensitivity.

Furthermore, not only can IBS symptoms be varied and multiple, but they may also coexist with or be initiated by other organic disorders (ie, ulcerative colitis or Crohn's disease).[28] Sometimes, therefore, it is difficult to determine whether the patient's symptoms are due to an organic (eg, inflammatory bowel disease [IBD]) or functional (eg, IBS) condition. From a biopsychosocial perspective, deciding whether a symptom is "functional" or "organic" is not as important as determining which factors need further attention.

Finally, it should be noted that while the symptoms described above help characterize the diagnosis of IBS, other types of symptoms or demographic and temporal features may help to exclude yet other disorders and direct the extent and nature of treatment. For example, symptoms that awaken the patient from sleep, present first at an older age, or manifest as GI bleeding, weight loss, or fever are regarded as alarm signs (also called "red flags"), and their presence should lead to further investigation

http://www.medscape.com/viewarticle/407962_2
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 9/30/2010 9:59 AM (GMT -7)   
I highly recommend this video as well.

It's Not All In Your Head: Understanding Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) affects 10 to 20 percent of the population, making it the most common gastrointestinal syndrome. But treatment remains difficult and misperceptions that it is psychosomatic disorder remain. Learn what modern science has unearthed about this syndrome as Pankaj Parischa, M.D. and professor at the Stanford University Medical Center, leads this engaging discussion about more rational forms of therapies and IBS research.

http://www.uwtv.org/programs/displayevent.aspx?rid=26275&fid=1698
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 10/9/2010 12:25 PM (GMT -7)   
another excellent resource.


THE JOHNS HOPKINS UNIVERSITY

Gastroenterology and Hepatology

IBS Information

http://www.hopkins-gi.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Disease_id=F5E21D6B-A88E-44F9-900F-7E295C50D38B&GDL_DC_id=D03119D7-57A3-4890-A717-CF1E7426C8BA
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 10/11/2010 2:54 PM (GMT -7)   
Douglas A. Drossman, MD on PBS

Co-Director UNC Chapel Hill FGID Douglas A. Drossman MD, Co-Director of Center speaks on Public Broadcasting Station on the Patient-Doctor relationship and IBS

Nationwide airings of PBS Talking about Your GI Health


http://www.med.unc.edu/medicine/fgidc/drossman_gihealth.htm
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

IBS_sucks
Regular Member


Date Joined Aug 2010
Total Posts : 47
   Posted 10/13/2010 8:17 PM (GMT -7)   
you are wrong about one thing, ibs IS a diagnosis of exclusion!

shawn12
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Date Joined Jul 2004
Total Posts : 1293
   Posted 10/14/2010 10:48 AM (GMT -7)   
First though is the change in diagnosing IBS that has been made.

"In the past two decades, medical opinion has changed regarding how to diagnose IBS. The older view emphasized that IBS should be regarded primarily as a "diagnosis of exclusion;" that is, diagnosed only after diagnostic testing excludes many disorders that could possibly cause the symptoms. Because many medical disorders can produce the cardinal IBS features of abdominal discomfort or pain and disturbed bowel habit as well as other symptoms caused by IBS, this approach often led to extensive diagnostic testing in many patients. Since the era when such thinking about IBS was common, laboratory, motility, radiologic, and endoscopic tests have proliferated. Although each of these tests is useful in evaluating certain problems, their routine or indiscriminate use can cause unnecessary inconvenience and cost for patients, and complications even occur infrequently from some of the tests. Fortunately, physicians can now diagnose IBS in most patients by recognizing certain symptom details, performing a physical examination, and undertaking limited diagnostic testing. This simpler approach is grounded on recent knowledge of the typical symptoms of IBS, and it leads to a reliable diagnosis in most cases. Extensive testing is usually reserved for special situations."

http://www.aboutibs..../diagnosis.html



Of course they are using Rome lll now but

New drugs—and some respect—for IBS
Revised guidelines and targeted therapies are leading to a new view of the condition

From the September ACP Observer, copyright © 2003 by the American College of Physicians.

Long disparaged as a "wastebasket disease," irritable bowel syndrome (IBS) appears to be gaining newfound respect among researchers, drug makers and gastroenterologists. The question now: Will other physicians begin to recognize IBS as a treatable condition, or will they continue to view it as a largely psychosomatic illness?

Researchers have made major strides in detecting the physiologic underpinnings of IBS as well as the nature of patients' "gut-brain" interactions. At the same time, drug makers now offer treatments that specifically target a broad range of IBS symptoms.

And gastroenterologists have identified the signs of IBS that can lead to a definitive diagnosis, crafting guidelines to help physicians distinguish IBS from other conditions.

But as many gastroenterologists are quick to point out, much of the progress being made on IBS has been lost on general practitioners. Rapid advances have created a "very big gap between primary care and gastroenterology," said Douglas A. Drossman, FACP, co-director of the University of North Carolina Center for Functional Gastrointestinal and Motility Disorders at Chapel Hill. "Primary care doctors are not up to speed."

To help close that gap, here is an overview of the latest developments in IBS research and treatment.

Help with the diagnosis

Until recently, physicians lacked a clear definition of what exactly constituted an IBS diagnosis. The condition required a diagnosis of exclusion, frustrating physicians and patients alike—and generally hampering treatment.

Even worse, arriving at an IBS diagnosis made many physicians fear they had missed a more dangerous condition such as colon cancer. Without any real guidance, it was difficult to feel sure that an IBS diagnosis didn't mean you were overlooking something more serious.

With the advent of new guidelines, known as the "Rome criteria," however, diagnosing irritable bowel syndrome has become more straightforward. The latest version of the criteria—Rome II—was developed by international experts and published in 2000. The criteria point to IBS as a genuine, treatable disorder.

The guidelines "give physicians something to hang a diagnosis on," said gastroenterologist Brian Lacy, MD, PhD, director of the Marvin M. Schuster Center for Digestive and Motility Disorders at Johns Hopkins Bayview Medical Center in Baltimore.

According to the Rome II criteria, patients suffering from IBS have experienced several specific symptoms for at least 12 weeks during the previous year. The guidelines emphasize that IBS is a multifaceted condition that involves not only a faulty defecation pattern, but pain. (For more on the Rome criteria, see "The Rome II diagnostic criteria for irritable bowel syndrome," below.)

"If they don't have pain, they don't have IBS," Dr. Lacy said, "even if they have diarrhea 15 times a day or go to the bathroom only once a month."

While the guidelines still require physicians to rule out other conditions such as functional diarrhea or pelvic floor disorders, both of which are similar to IBS, experts say the criteria reduce much of the diagnostic uncertainty by limiting the range of other possible conditions. You don't need to run most patients through an extensive battery of tests to reach a diagnosis.

Last year, both the American Gastroenterological Association and the American College of Gastroenterology (ACG) issued position statements that agree with that diagnostic approach. The organizations identified key "alarm signals" that should alert you to other potential diagnoses when working with possible IBS patients.

Those signals include blood in the stool, unexplained weight loss, anemia, chronic severe diarrhea, recurring fever and a family history of colon cancer. In the absence of such red flags, however, the statements claimed that the Rome II criteria are nearly 100% specific in diagnosing IBS—and that the risk of missing another disease is negligible.

While you may feel compelled to list several problems like pain, bloating and constipation when treating IBS patients, Dr. Lacy said that approach is unnecessary. "These patients have one unifying diagnosis—IBS—that should make it easier to treat them," he explained. "You need to think about treating this whole constellation of symptoms."

Performing fewer tests to make an IBS diagnosis benefits not only health plans, but patients themselves. Excessive testing can distress patients, noted gastroenterologist George F. Longstreth, MD, chief of gastroenterology at Kaiser Permanente Medical Care Program in San Diego.

"Too many tests sometimes create more anxiety," he said, a factor that can be a real liability when research suggests that IBS patients may have more pronounced intestinal reactions to stress than other patients. (For more on the "gut-brain" connection, see "IBS: An anatomy of what goes wrong in the body," below.)

And while internists instinctively worry about missing another disease, they need to guard against making the opposite mistake: confusing IBS symptoms for those of other medical conditions.

Studies have shown, for example, that IBS patients are more likely to have their gallbladders removed or to have a hysterectomy. "IBS patients shouldn't automatically have their gallbladders taken out," Dr. Longstreth said. "Their pain may be due to IBS."


So IBS being a diagnoses of exclusion changed years ago.
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

IBS_sucks
Regular Member


Date Joined Aug 2010
Total Posts : 47
   Posted 10/14/2010 11:11 AM (GMT -7)   
I had about 15 to 20 different tests ran on me. Everytime they were not looking fro IBS. The were looking for a different disease, and were able to exclude those diseases. Then when my GI Dr. wanted to give up testing i was then diagnosed with IBS. So yes IBS is still a diagnoses of exclusion. Until a Dr. can run a medical test and say look here is proof that this patient has IBS, then it will always be a diagnoses of exclusion. They can add as many "red flags" or create a rome IV with even more percise qualifications/classifications, but until there is a test that Dr.s can run to actually look for IBS, then it will always be a diagnoses of exclusion. Doctors or FDA people or the people who create the rome criteria can sugar coat it all they want and say the diagnoses is more percise, it is still a diagnoses of exclusion. Sorry, you do have a lot of good information here and thank you for your work, but until your can name me a test that will prove I have IBS, I really don't see how my mind can change on this matter.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 10/14/2010 12:32 PM (GMT -7)   
IBS-sucks, with all due respect you don't understand the work that has been done on all this over the last ten years. There are a major reasons for the change in thinking on diagnosing IBS and the fact they have learned a lot more about IBS.
Part of this was how to accurately diagnose IBS without a biological marker. Using the rome criteira IBS is a stable diagnoses. The slide is from 1995.
 
VIEW IMAGE
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 10/14/2010 3:18 PM (GMT -7)   
Diagnostic Testing in Irritable Bowel Syndrome: Theory vs. Reality
By: Brennan M.R. Spiegel, M.D., VA Greater Los Angeles Healthcare System; David Geffen School of Medicine at UCLA; UCLA/VA Center for Outcomes Research and Education (CORE), Los Angeles, CA

Dr. Spiegel is the recipient of the 2007 IFFGD Research Award for Junior Investigator – Clinical Science. His current research is looking at ways to improve the quality and cost-effectiveness of care for patients with IBS and other functional GI disorders.

Summary
Although irritable bowel syndrome (IBS) is extremely prevalent, affecting up to 15% of the general population, diagnosing IBS is not always straightforward. Properly diagnosing IBS can be challenging and uncertain for several reasons.

Despite the tendency to order diagnostic tests in the face of IBS symptoms, the diagnostic criteria for IBS, such as those supported by the Rome Committee, encourage clinicians to make a positive diagnosis on the basis of validated symptom criteria, and emphasize that IBS is not a diagnosis of exclusion despite the extensive list of other conditions that masquerade as IBS.

The current Rome guidelines for IBS state that IBS can be diagnosed in the absence of 'alarm features,' and is 'often properly diagnosed without testing.' When alarm features are present, the diagnosis of IBS should not be made. However, the part about diagnosing IBS 'without testing' can be murky ground for clinicians. This uncertainty leads to rampant diagnostic testing in IBS.

Why do providers continue to order tests in IBS, despite data that these tests are generally low yield? That is, why is there mismatch between academic theory and clinical reality? Assuming there are no alarming signs or symptoms, clinicians should focus less on diagnostic testing and focus more on education and treatment.

Ultimately, patients and their doctors should use their judgment, and must reserve the right to investigate further if the IBS doesn’t 'follow the script,' so to speak, either because of a poor response to therapy, worsening of symptoms over time despite treatment, or development of new alarming features. Like most things in medicine, diagnostic testing in IBS remains a balance of art and science.

http://giresearch.org/site/gi-research/iffgd-research-awards/2007/diagnostic-testing
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 10/14/2010 3:26 PM (GMT -7)   
FYI

Diagnosis of IBS

http://aboutibs.org/site/about-ibs/symptoms/diagnosis

Is it IBS or Something Else?Physicians can usually identify irritable bowel syndrome (IBS) from patients' symptoms. Many patients additionally require only routine blood tests and a colon evaluation, and some require no tests at all to secure the diagnosis. However, some patients worry that they could have another cause for their symptoms, especially when symptoms are severe and chronic, or they know other people who they think had similar symptoms but a different disorder. Occasionally, another medical problem mimics IBS symptoms. This discussion focuses on how IBS is diagnosed and distinguished from other disorders. Reviewed and updated 2009.

http://www.aboutibs.org/store/viewproduct/195


Current Approach to the Diagnosis of Irritable Bowel SyndromeIn the past two decades, medical opinion has changed regarding how to diagnose IBS. The older view emphasized that IBS should be regarded primarily as a "diagnosis of exclusion;" that is, diagnosed only after diagnostic testing excludes many disorders that could possibly cause the symptoms. Fortunately, physicians can now diagnose IBS in most patients by recognizing certain symptom details, performing a physical examination, and undertaking limited diagnostic testing. This simpler approach is grounded on recent knowledge...and it leads to a reliable diagnosis in most cases. Revised and updated 2009.

http://www.aboutibs.org/store/viewproduct/163

Diagnostic Tests in Irritable Bowel Syndrome PatientsThe diagnosis of IBS is made through a careful history and physical examination as well as the performance of a limited medical evaluation with a variety of tests. In the absence of a definitive test, formal symptom-based criteria have been developed for the diagnosis of IBS. When are diagnostic tests indicated? A review of diagnostic evaluation of patients with suspected IBS including structural tests (like x-ray or colonoscopy), blood tests, stool analysis, and breath tests.

http://www.aboutibs.org/store/viewproduct/175


Diagnosis of Irritable Bowel Syndrome: The Diagnosis

Symptom-Based Criteria
The use of symptom-based criteria allows the physician to make a "positive diagnosis" of IBS, thereby reducing the need for excess diagnostic tests/studies to exclude other conditions. These criteria also serve to legitimize the disorder to patients and physicians. However, developing diagnostic criteria is challenging because of the absence of specific physical or biochemical findings, the variability of the symptoms (with regard to pattern, location, and severity) among patients -- and even in the same patient over time, and the inconsistency of the clinical course. Several symptom-based diagnostic approaches for IBS have been proposed over the last 2 decades in an attempt to standardize the diagnosis and increase its specificity. These criteria were selected through use of clusters of symptoms thought to be consistent with the disorder.[11,12]

In a study done 20 years ago, 6 symptoms were identified that differentiate between patients with irritable bowel from those with organic intestinal diseases.[41] These symptoms, later known as the "Manning criteria," for the first time suggested the feasibility of a positive diagnostic approach to IBS based on symptom criteria. Although widely used in epidemiologic and clinical studies, these criteria have been of limited clinical value in differentiating IBS from organic, lower GI tract diseases.[42] Nevertheless, they have provided the basis for the more recent "Rome criteria," first published for IBS in 1989[43] and for all of the functional GI disorders in 1990.[10]

The Rome criteria. The Rome criteria were first developed by international consensus ("Delphi" approach). These multinational working teams also critically reviewed the literature on the epidemiology, pathophysiology, diagnostic approach, and treatment for IBS and other functional GI disorders. The original criteria (ie, "Rome I")[44] have recently been revised ("Rome II") and published as a book and journal supplement.[45] The Rome II criteria for IBS are shown in the Table below. Over the 20 years since publication of the Manning criteria, the use of symptom-based criteria for the diagnosis of IBS has become accepted as the diagnostic standard for research and clinical care.

According to these criteria, the presence of abdominal pain/discomfort is required for the diagnosis of IBS. The pain or discomfort must be associated with at least 2 of the 3 criteria that link the pain to change in bowel habit (see Table). Therefore, pain/discomfort alone, or with only 1 of the 3 criteria, or the existence of altered stool habit (ie, frequency or stool form) without pain/discomfort is not sufficient for the diagnosis of IBS. Patients may have other functional bowel symptoms that do not fulfill the criteria for IBS. These symptoms may represent different functional bowel diagnoses, such as functional abdominal pain, functional constipation, functional diarrhea, functional abdominal bloating, or unspecified functional bowel disorder.

The Rome criteria also require certain temporal features for the diagnosis. Symptoms must be present "at least 12 weeks or more, which need not be consecutive, in the preceding 12 months," and this can apply to any 12 weeks in a year. Thus, symptoms need not be consecutive, and the chronicity criterion can be fulfilled even if the symptoms are present for only 1 day in a week. For epidemiologic surveys, symptoms may be present for 3 weeks over a 3-month period (25% of the time).

The Rome II criteria for IBS have been modified from the Rome I criteria in several ways: (1) They have been simplified by defining the specific symptoms regarding bowel habit (eg, > 3 bowel movements per week, straining at stool, hard stool) as only supportive rather than diagnostic of IBS; (2) Two of the 3 major criteria (rather than 1 of 3 for Rome I criteria) are now required for the diagnosis; and (3) Symptoms must be present for a longer time frame (12 weeks/year, rather than 3 weeks/3 months). These symptom item changes were based on new empiric evidence that helps to validate the criteria (primarily, factor analytic studies).

Subclassification of IBS
IBS can be stratified by subgroup based on predominant symptom or severity. These subclassifications can help the clinician to determine diagnostic (to exclude other diseases) and treatment approaches, and to stratify study populations for clinical trials.

Predominant symptom subclassification. IBS is often subclassified as diarrhea-predominant, constipation-predominant, or alternating (combination of both) at varying times. The Rome multinational working team proposed guidelines for predominant symptomsubclassification based on stool frequency, stool form, and stool passage. However, because IBS is characterized by dysregulation of bowel function, patients may often alternate between these subgroups, and thus their predominant symptom may change over time.[18,46] Moreover, a long-term study on the natural history of IBS and dyspepsia has shown that the predominant functional symptom can change over time not only within the specific diagnosis/disorder (eg, IBS), but also between different functional disorders (eg, IBS and dyspepsia).[17,18]

Symptom severity subclassification. Another strategy of subclassifying IBS patients is by the severity of the symptoms. Most subjects who have IBS symptoms do not see physicians for their symptoms (ie, IBS nonpatients). The majority (about 70%) of the subjects who do see physicians (ie, IBS patients) have mild and infrequent symptoms associated with little disability.[47] Twenty-five percent of IBS patients have moderate symptoms, which may occasionally interfere with daily activities (such as missing school, work, or social functions), and only a small proportion (about 5%) have severe symptomsthat considerably affect daily activities and quality of life.

The severity of IBS symptoms is determined by their intensity, constancy, the degree of psychosocial difficulties, and the frequency of healthcare utilization.[11,31,47] Subclassifying IBS patients according to the severity of their symptoms can be helpful in guiding proper management. For example, patients with mild and infrequent symptoms can be managed by primary care physicians and usually require only reassurance, education, and dietary or lifestyle changes. Patients with moderate symptoms may require, in addition, pharmacologic and/or behavioral treatments. Patients who have severe, more frequent, or constant symptoms often require psychopharmacologic (eg, antidepressants) and/or psychological (eg, cognitive-behavioral) interventions and may need to be referred to tertiary centers.[11,12,47]

Diagnostic Testing
Once the diagnostic criteria have been met, it is necessary to exclude other medical disorders having similar clinical presentations. This is done by looking for alarm signs (see above)andby performing limited diagnostic screening tests. The diagnostic strategy should be planned in a cost-effective manner with consideration of the duration of the symptoms, age of onset of symptoms, family history of colon cancer, severity of the symptoms, previous diagnostic evaluations, psychosocial status, and change of symptoms over time.

Detailed recommendations for diagnostic tests that can be used in this setting are found elsewhere.[3,11,12] In brief, the initial screening evaluation should include at least blood tests (eg, blood count, erythrocyte sedimentation rate, serum chemistries), stool tests (eg, for ova and parasites and blood), and sigmoidoscopy. Other studies such as colonoscopy, barium enema, ultrasound, or CT scan will depend on the presence of "alarm" signs as well as factors such as the patient's age and family history. More specific studies (eg, lactose breath hydrogen test, thyroid-stimulating hormone determination, celiac sprue serology) should be considered if indicated by features in the patient history or results of screening studies that point to other diagnoses.

If the initial screening evaluation is normal, further diagnostic studies should be withheld and treatment may be started with a follow-up visit within 4-6 weeks.[11] The patient should be reevaluated over time and additional diagnostic tests obtained depending on changes in clinical status and response to treatment. Nevertheless, it should be emphasized that the mere persistence of symptoms does not justify further diagnostic testing. Because IBS is a chronic disorder with frequent relapses, repeating diagnostic studies to "convince" the patient, or to rule out other disease entities, is not only unjustified but may be harmful in that it undermines the patient's confidence in both the diagnosis and the physician.

Factors such as the severity of the symptoms, the patient's illness behavior (eg, recurrent complaints, recurrent physician visits and phone calls, requests for further testing), and even an incomplete response to symptomatic treatment must be considered in the management approach. However, these factors do not justify additional diagnostic testing in the absence of other "alarm" signs (eg, blood in the stool, abnormal physical examination, or laboratory studies). Rather, they may reflect the degree of psychosocial difficulties. As discussed earlier, psychosocial assessment is an essential part of the patient's evaluation and diagnostic planning. Clinicians should look for psychosocial factors that may exacerbate the clinical expression of the symptoms as well as the patient's illness behavior. Identifying or excluding these factors is helpful in establishing an appropriate diagnostic plan and in minimizing unneeded investigative studies.

Validity of the Diagnosis
How confident can a physician (and the patient) be with the diagnosis? In addition to the symptoms included in the major criteria, the Rome committee also listed symptoms that are not essential for the diagnosis but that are commonly present in patients with IBS (see Table). The presence of these symptoms can add to the physician's confidence regarding the origin of the symptoms (ie, GI) and the diagnosis (ie, IBS).[41] Nevertheless, development of symptom-based criteria in the absence of a diagnostic ("gold") standard has obvious limitations. The consensus achieved by expert clinicians and investigators can only provide face validity, and additional validation studies are needed to support the utility of the published criteria. Unfortunately, available data on the validity of the Rome criteria are still limited.

In a recent study, Vanner and colleagues[48] examined the predictive value of the Rome I criteria using the gastroenterologist's final diagnosis as the gold standard. The study authors found that the combination of the Rome criteria and the absence of "red flags" (weight loss, nocturnal symptoms, blood in stools, recent antibiotic use, family history of colon cancer, and abnormal physical examination) yielded 63% sensitivity and 100% specificity, with a positive predictive value (PPV) of 98% to 100% and negative predictive value of 76%. Additional studies on the validation of the Rome criteria, particularly the new (Rome II) criteria, are currently under way.

Additional support for a positive diagnosis of IBS also comes from studies that have looked at long-term outcomes. In long-term follow-up studies (up to 9 years from the diagnosis), no other explanation for the symptoms was found in 95% to 100% of patients.[49-51] This suggests that a positive diagnosis using symptom-based criteria, the absence of "red flags," and limited investigations rarely requires revision.

http://www.medscape.com/viewarticle/407962_3
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 10/19/2010 10:42 AM (GMT -7)   
Educational Materials

http://www.med.unc.edu/medicine/fgidc/public_education_materials.htm
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 10/19/2010 11:06 AM (GMT -7)   

Toward a Positive and Comprehensive Diagnosis of Irritable Bowel Syndrome

 

http://www.ibsgroup.org/other/pnt-mgi7350.ring.html


IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 10/26/2010 10:50 AM (GMT -7)   
more educational information.

http://www.ibs.med.ucla.edu/PatientArticles.htm
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

dancinheart
Regular Member


Date Joined Oct 2010
Total Posts : 34
   Posted 10/30/2010 9:10 AM (GMT -7)   
I am new to this site but find myself dealing with taumatic ptsd IBS for the last 2 yrs!! It is much better since I have found the cause. STRESS is the killer. There are other side effects in the surrounding areas like interstitial cystitis and female problems. Pain was excruciating and the suffering each and every day was unbelievable!! No Dr. could diagnose what was wrong. Endoscopys, colonoscopys, catscans, ER doubled up in excruciating pain. I thought I had to have cancer!! In hospital didnt help.  The cause and the cure came from finding out what is causing all the gutt reactions caused by the stressful situation my mind and body were forced to endure for so many years !! We become all things to all people and become nothing to ourselves until we physically self destruct.  Since so many of our emotions are based in our G.I. tract it makes sense this is where we will first be effected, or so I have been led to understand.  I have been told 90% of our seratonin receptors are in our gutt!! I have found yoga, meditation, exercise walking and Tai Chi r amazing for the mind and spirit which immediately affect IBS. I have very little symptoms now until I am again under adrenalin anxiety situations. Get Out of The Pressure cooker somehow. Find a way and you will find health again!!

IamCurious
Veteran Member


Date Joined Jan 2010
Total Posts : 2827
   Posted 11/3/2010 1:28 PM (GMT -7)   
I suffer from IBD not IBS. Not all doctors recommend probiotics for IBD but among forum members with IBD they have an excellent reputation for alleviating symptoms.

Supposedly Bifantis, (Bifidobacterium infantis) is the one probiotic that is especially effective for IBS as well as IBD. It is one of the 8 strains of bacteria in VSL#3. Also found in UDO's probiotic for infants and in Align. It is probably in other probiotics as well, check labels.
59 y/o male. DX ulcerative colitis Feb08, possible Crohn's colitis DX March 2010.
No Meds, allergic to Mesalamine. Allergy to shellfish contributed to 1st major flare.
Watch diet to maintain remission. Boswellia and psyllium seeds especially helpful.

E. Coli Nissle (Mutaflor), turmeric, fish oil, S. Boulardii, VSL3, resveratrol, multivitamin, extra D3, K2, C, high gamma E, magnesium, DGL, phosphatityl choline, glutamine. Lots of fruit and vegetables (but no plums), no soda, no HFCS, no trans fat, tea instead of coffee, few processed foods, no carrageenan.

Nature created all of the locks, therefore Nature has all of the keys

Post Edited (BabeintheWoods) : 11/3/2010 2:31:16 PM (GMT-6)


shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 11/4/2010 12:49 PM (GMT -7)   
Certain probiotics have been found to help repair immune cells. I believe Bifidobacterium infantis is one of them.
 
Probiotics at this time haven't shown a ton of effectiveness, but some effectiveness on certain symptoms at this time.
 
 
 
 
 
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

UK Guy
Regular Member


Date Joined Nov 2010
Total Posts : 22
   Posted 11/13/2010 12:46 PM (GMT -7)   
Can i just say Shawn, as someone who is feeling extremely vulnerable / scared stiff at the moment, how valuable your above posts are.

It is amazing how much work and time you must have put into it all...

Regardless of what my diagnosis i may receive this week, i'd like to say a massive thank you.

Dave

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 11/18/2010 11:23 AM (GMT -7)   
UK Guy, I am glad they are helping and I have spent a ton of time on al this so thank you.

Let me know how its going and if you have any questions.
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 11/30/2010 10:33 AM (GMT -7)   
bump for the resources
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

shawn12
Veteran Member


Date Joined Jul 2004
Total Posts : 1293
   Posted 12/17/2010 2:57 PM (GMT -7)   
bump
IBS Forum Moderator


I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.
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