Many Americans today carry a diagnosis of IBS - Irritable Bowel Syndrome - some estimates are as high as 45 million patients. There are many therapies offered to combat the diarrhea, abdominal pain and emotional distress ranging from medications, herbal supplements, and diets to yoga, behavioral therapies, and lifestyle changes. Yet despite all these options only a smaller percentage than we as providers like find that their symptoms are well controlled.
Why is this?
Well, to start there is no specific test to diagnose IBS; rather there are accepted signs and symptoms, called the Rome Criteria (currently in version 4), and if you meet enough of them you can have a diagnosis.
So if I meet these "Rome Criteria" that means I have IBS?
Not necessarily. One of the main issues at hand is that many of these symptoms are nonspecific and may overlap with other diagnoses. You may have even seen marketing recently for tests that will "diagnose" IBS - but in fact these tests (as of the time of publishing this article) just suggest that you may or may not have it.
How is this typically evaluated? When would I be told I have IBS?
When you see a gastroenterologist for chronic diarrhea you will often undergo some level of testing which will often include stool samples and a colonoscopy. What is actually being tested in the stool can vary, and what and where you get biopsies varies. For many years this is all we had at our disposal from a diagnostic perspective. Often at this point if everything is negative and you do not have "alarm" symptoms, you were diagnosed with IBS. I have seen many patients in my career carrying a diagnosis of IBS, not doing very well from a symptom-control standpoint, who undergo further evaluation (or re-evaluation) with either newer more-expansive stool testing or even further testing with Endoscopic Ultrasound and find diagnoses such as Bile Salt Diarrhea, Chronic Pancreatitis, Microscopic Colitis, Celiac Disease, and EPI - Exocrine Pancreatic Insufficiency.
EPI - I've been hearing about that on TV and the internet
Yes EPI has become somewhat of a buzzword in the media. You use your pancreas to produce insulin as well as other enzymes related to digestion. The most common reason for insufficient (low) levels of enzyme is chronic pancreatitis, however many patients with an otherwise normal pancreas may suffer from it as well. Symptoms can be remarkably similar to IBS - bloating, pain, nausea, diarrhea - so you can see how it can be easily missed if you aren't looking for it.
Do you think I really have IBS? Should I get re-evaluated?
Well if you are doing well without symptoms I think there may not be any added value - if it ain't broke, don't fix it as they say. But if you still have a significant amount of symptoms - and especially if you have alarm symptoms such as weight loss or bleeding - then you should seek evaluation. Especially when it comes to evaluation of more minor chronic changes of the pancreas, Endoscopic Ultrasound - an endoscopic exam when an ultrasound is used while you are sleeping to get a picture of your pancreas - is more sensitive sometimes than other imaging choices such as CT or MRI. If you find another reason for the diarrhea or discomfort you may be able to attack it head-on rather than using remedies to cover up the problem, you can apply therapy directly to combat it at the source.
DISCLAIMER: Please note that this blog is intended for Informational Use only and is not intended to replace personal evaluation and treatment by a medical provider. The information provided on this website is not intended as substitute for medical advice or treatment. Please consult your doctor for any information related to your personal care.