Dailybloom® for IBS by
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Despite the high prevalence of irritable bowel syndrome (IBS), accurately diagnosing the condition remains challenging. Due to the absence of reliable biological markers, clinicians often rely heavily on patient-reported symptoms, which can vary widely and are difficult to objectively evaluate.
Furthermore, various organic gastrointestinal disorders can mimic IBS, raising concerns about overlooking other possible diagnoses such as inflammatory bowel disease, microscopic colitis, infectious colitis, celiac disease, and colon cancer. This uncertainty often leads practitioners to use a diagnosis of exclusion, involving numerous unnecessary, expensive, and invasive tests.
This approach delays the initiation of appropriate IBS treatment. On average, it takes four years for a patient to receive an accurate diagnosis of IBS. The stigma associated with IBS can lead patients to believe that their symptoms are not taken seriously and that effective treatment is inaccessible.
Both the American College of Gastroenterology (ACG) and the British Society of Gastroenterology (BSG) recommend a positive diagnostic strategy over exclusion.
A positive diagnostic strategy includes detailed patient histories, thorough physical examinations, and the application of standard definitions with limited diagnostic tests to accurately diagnose IBS.
In countries like India, diagnosing IBS poses additional challenges due to language barriers and cultural variations, heavily relying on symptom criteria. More than 80% of physicians agree that IBS is characterized by recurrent abdominal pain or discomfort associated with defecation or a change in bowel habits, in the absence of organic causes detectable by routine tests.
A thorough work-up includes careful history taking with reference to IBS diagnostic criteria, physical examinations, and selected investigations if indicated. There is no single diagnostic or confirmatory test for IBS.
Alarm symptoms or conditions to be excluded include the presence of blood in the stools, unintended weight loss, anemia, nocturnal symptoms, fever, abdominal mass, ascites, a family history of colorectal cancer, and onset age over 50 years.
Colonoscopy is recommended if patients present with alarming symptoms like rectal bleeding, positive fecal occult blood test (FOBT) results, anemia, fever, nocturnal symptoms, unintended weight loss within the past three months, onset age over 50 years, and a family history of colorectal cancer, inflammatory bowel disease, or celiac disease. Most organic diseases are ruled out through colonoscopy.
Non-invasive laboratory tests to exclude organic causes in patients without alarm features include full blood counts with erythrocyte sedimentation rate, blood chemistry with C-reactive protein, and stool examinations for occult blood and fecal calprotectin.
Normal C-reactive protein and fecal calprotectin levels in non-constipation IBS patients help exclude inflammatory bowel disease. Stool examinations for intestinal parasites should be performed in countries with a high prevalence of intestinal parasites.
Routine stool testing for enteric pathogens can be considered for patients presenting with chronic symptoms like bloating, diarrhea, and abdominal pain resembling IBS.
Normal defecation requires coordination between the contraction of abdominal muscles that increase intra-rectal pressure and the relaxation of the pelvic floor, including the anal sphincter. Pubo-rectal dyssynergia is a common type of fecal evacuation disorder (FED).
Different types of pubo-rectal dyssynergia are characterized by a lack of increase in intra-rectal pressure or reduction in residual pressure in the anal canal during attempted defecation. Asian studies, particularly Indian studies, suggest that patients with FED may present as constipation-predominant IBS.
Wheat sensitivity or non-celiac gluten sensitivity (NCGS) is increasingly recognized within the spectrum of gluten-related disorders and is characterized by bowel symptoms similar to IBS. Evidence from several Asian countries indicates the presence of NCGS in patients fulfilling IBS criteria.
Food intolerances are characterized by non-immunological gastrointestinal reactions triggered by the consumption of certain foods, leading to symptoms like abdominal pain, bloating, and changes in bowel habits. Unlike food allergies, these intolerances often exhibit a dose-dependent pattern, where small amounts of the trigger food may be tolerated well, but larger quantities can cause significant discomfort.
Lastly, IBS is associated with significant impairment in quality of life (QOL), social functioning, sleep, and psychological well-being. Validated questionnaires should be considered as supportive tools for the quantitative and objective assessment of QOL impairment and psychological distress.
Tools like Short Form 36, EuroQol 5 Dimension, Hospital Anxiety and Depression Scale, Patient Health Questionnaire, and IBS-QOL have been utilized in Asian studies.
Dr. Pranav Shukla
MBBS, MD Anaesthesia
Disclaimer: This communication does not substitute advice of a medical/healthcare practitioner. Please consult your doctor/healthcare professional for any medical/healthcare advice. Although greatest possible care has been taken in preparation of this response, Dr Reddy's shall not be liable to any person for contents of the same. Images appearing herein are for illustration purposes only.
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