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Getting the BS out of Irritable Bowel Syndrome with Diarrhea (IBS-D): Let’s Make a Diagnosis

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Abstract

Purpose of review

Irritable bowel syndrome with diarrhea (IBS-D) is diagnosed when chronic symptoms of abdominal pain accompany loose stools, and alarm features, such as fever, anemia, rectal bleeding, and weight loss are absent. This combination of symptoms makes structural disorders, such as inflammatory bowel disease or cancer, unlikely, but does not exclude other conditions that cause these symptoms. The question is whether making a “positive diagnosis” of IBS-D based on symptoms alone and instituting therapy based on that diagnosis still makes sense.

Recent findings

Clinical observations suggest that at least two-thirds of cases of IBS-D can be explained by three mechanisms: a) food intolerances (~ 30—40%), b) bile acid diarrhea (~ 20—30%), and c) disturbed microbial flora (~ 15—20%). Other conditions that are less frequent but can cause IBS symptoms or be confused with IBS include: celiac disease, microscopic colitis, mastocytosis/mast cell activation, and drug side-effects.

Summary

Many cases of IBS-D have a discoverable, underlying cause that can direct therapy more efficiently.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, The Weill Medical College of Cornell University, 1283 York Avenue, Floor 9, New York, NY, US, 10021

    Christine L. Frissora

  2. Department of Medical Education, Texas A&M University School of Medicine, Dallas Campus, and Chair, Institutional Review Boards for Human Subject Protection, Baylor Scott & White Research Institute, Dallas, TX, US

    Lawrence R. Schiller

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Contributions

Dr. Frissora was involved with the conception of this review. Dr. Frissora and Dr. Schiller were equally involved with the acquisition, analysis and interpretation of data for the work, drafting the review, critical review of intellectual content, final approval, and accountability for the work.

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Correspondence to Christine L. Frissora.

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Competing interests

Disclosures: Dr. Frissora reports non-financial support from QOL Speaker bureau, personal fees from Advisory boards: Ardelyx, Ironwood, Salix, personal fees from Legal consulting work, other from GI Reconnect, other from Vibrant Capsule Advisory Board, Israel, non-financial support from TRAC Tri-Institutional Research Advancement Center Committee Weill Cornell Medical Center, outside the submitted work. Dr. Schiller reports personal fees from Salix Pharmaceuticals, outside the submitted work.

Ethics Approval

Ethics approval was not required for this review.

Disclosures

Dr. Frissora reports non-financial support from QOL Speaker bureau, personal fees from Advisory boards: Ardelyx, Ironwood, Salix, personal fees from Legal consulting work, other from GI Reconnect, other from Vibrant Capsule Advisory Board, Israel, non-financial support from TRAC Tri-Institutional Research Advancement Center Committee Weill Cornell Medical Center, outside the submitted work. Dr. Schiller reports personal fees from Salix Pharmaceuticals, outside the submitted work.

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Frissora, C.L., Schiller, L.R. Getting the BS out of Irritable Bowel Syndrome with Diarrhea (IBS-D): Let’s Make a Diagnosis. Curr Gastroenterol Rep 26, 20–29 (2024). https://doi.org/10.1007/s11894-023-00909-1

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