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Irritable Bowel Syndrome

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Sex- and Gender-Based Women's Health

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Abstract

Irritable bowel syndrome (IBS) is a functional bowel disorder that is commonly encountered by primary care providers and gastroenterologists. IBS is diagnosed based on clinical symptoms in the majority of patients, without the need for extensive laboratory, radiographic, or endoscopic testing, after the exclusion of organic diseases. IBS is classified into subtypes based on the predominant bowel habit: constipation, diarrhea, mixed, or un-subtyped. Patients with IBS are often frustrated with their symptoms, and reassurance is critical in the management of patients. Initial treatment strategies should focus on lifestyle modification including diet and exercise; however, some patients will need pharmacological treatment to target symptom relief, be it regulating bowel movements or addressing abdominal cramping and spasms.

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Author information

Authors and Affiliations

  1. Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Rachel Vanderberg

  2. San Francisco VA Medical Center, University of San Francisco Medical Center, San Francisco, CA, USA

    Amy D. Lu

  3. Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA

    Jana G. Hashash

  4. American University of Beirut, Beirut, Lebanon

    Jana G. Hashash

Authors
  1. Rachel Vanderberg
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  2. Amy D. Lu
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  3. Jana G. Hashash
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Corresponding author

Correspondence to Rachel Vanderberg .

Editor information

Editors and Affiliations

  1. University of Pittsburgh School of Medicine, Division of General Internal Medicine, Department of Medicine, Pittsburgh, PA, USA

    Sarah A. Tilstra

  2. Harvard Medical School, Massachusetts General Hospital, Department of Medicine, Boston, MA, USA

    Deborah Kwolek

  3. Medical College of Wisconsin, Milwaukee, WI, USA

    Julie L. Mitchell

  4. Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Department of Medicine, Chicago, IL, USA

    Brigid M. Dolan

  5. Hackensack Meridian School of Medicine at Seton Hall, Jersey Shore University Medical Center, Department of Medicine, Neptune, NJ, USA

    Michael P. Carson

Review Questions

Review Questions

  1. 1.

    A 25-year-old female presents to your clinic with complaints of intermittent abdominal pain associated with diarrhea for the past 6 months. She states she has abdominal pain and loose stools multiple times a day about twice a week. She denies any GI bleeding, nocturnal symptoms, weight loss, or family history of inflammatory bowel disease but notes that her symptoms seem to be worse during times of increased stress. On physical exam, she is afebrile, HR: 70 beats/min, BP: 110/65 mmHg. Abdominal exam reveals normoactive bowel sounds, diffuse mild tenderness, no rebound or guarding, and no masses. Which of the following is the next best diagnostic step?

    1. A.

      Colonoscopy

    2. B.

      Fecal leukocytes

    3. C.

      CT abdomen and pelvis

    4. D.

      Apply Rome IV criteria

    5. E.

      Watchful waiting

The correct answer is D. This patient displays no “red flag” features that would indicate underlying GI tract or systemic pathology. The Rome IV criteria can be applied to this patient to facilitate a clinical diagnosis without additional diagnostics as she is presenting with complaints consistent with irritable bowel syndrome without alarm features [16]. Early diagnosis helps accelerate a treatment plan and increases patient satisfaction. Should this patient not respond to first-line treatment or her symptoms progress, additional workup should be pursued.

  1. 2.

    A 51-year-old Caucasian female presents to the clinic to establish care. She reports intermittent abdominal pain and bloating associated with diarrhea. The symptoms have been present for several years, and she denies rectal bleeding, weight loss, and nocturnal symptoms. On average, the symptoms occur once a week. She has a copy of prior medical evaluations which reveal normal thyroid function tests, normal IgA levels, negative celiac disease panel, and normal fecal calprotectin level. She has never had a colonoscopy. She uses loperamide as needed, and this adequately controls her symptoms. Which of the following is the next best step?

    1. A.

      No further testing is required.

    2. B.

      C-reactive protein.

    3. C.

      Colonoscopy.

    4. D.

      Fecal elastase.

    5. E.

      Stool ova and parasite.

The correct answer is C. All patients with IBS should undergo age-appropriate colorectal cancer screening. In this Caucasian female with no family history of colon cancer, screening for colon cancer should start at 50 years of age [72].

  1. 3.

    A 45-year-old female with depression and constipation-predominant irritable bowel syndrome returns to your clinic for follow-up. She reports exercising regularly and staying hydrated. Her depression is well controlled with sertraline and cognitive behavior therapy. She has previously tried taking polyethylene glycol twice a day to help with her constipation without significant relief. Most recently, she tried linaclotide for 6 weeks, again, without relief of her symptoms. What is the next best step in management?

    1. A.

      Referral to gastroenterology

    2. B.

      Switch linaclotide to lubiprostone

    3. C.

      Start a gluten-free diet

    4. D.

      Start senna

The correct answer is A. Patients who fail nonpharmacological and pharmacological management should be referred to gastroenterology for further evaluation including other possible etiologies of constipation and/or additional management considerations [24, 25].

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Vanderberg, R., Lu, A.D., Hashash, J.G. (2020). Irritable Bowel Syndrome. In: Tilstra, S.A., Kwolek, D., Mitchell, J.L., Dolan, B.M., Carson, M.P. (eds) Sex- and Gender-Based Women's Health. Springer, Cham. https://doi.org/10.1007/978-3-030-50695-7_27

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