Posted 3/14/2011 12:50 PM (GMT -6)
There is a reason they don't do colonoscopies on everyone.
There is a reason IBS is now based on certain criteria called thee Rome criteria.
"The symptom-based Rome diagnostic criteria for IBS emphasize a “positive diagnosis” rather than exhaustive tests to exclude other diseases.
You want them to use the Rome criteria to help them diagnose you accurately.
Current Approach to the Diagnosis of Irritable Bowel Syndrome
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. 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.
Diagnosis of IBS
Diagnostic Testing in Irritable Bowel Syndrome: Theory vs. Reality
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.