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Diagnosing IBS with confidence

While there are no definitive tests to diagnose IBS, Rome criteria are the basis of an IBS diagnosis, and are utilized in consideration with patient clinical history, physical examination, and minimal laboratory tests.1 Therefore, IBS is not a diagnosis of exclusion, but rather an affirmative, symptom-based diagnosis,2 using criteria with a 98% positive predictive value for IBS.3

Tools that may improve diagnostic confidence could enhance the care of patients with IBS and prevent delay to treatment. The IBS CounSEL has developed a diagnosis toolkit,a which includes a screening checklist, information about Rome criteria and the Bristol Stool Form Scale, and a diagnostic pathway. These resources are intended to assist healthcare professionals in the diagnosis of IBS. The screening checklist helps to identify key IBS symptoms, as well as any alarm symptoms which may indicate an alternative diagnosis; information on both Rome criteria and the Bristol Stool Form Scale provide critical educational guidance on how IBS is diagnosed; and the diagnostic pathway applies this information to outline the steps that can be taken to assist in the diagnosis of IBS. Taken together, these criteria can be applied through the use of diagnostic tools to increase confidence in a diagnosis of IBS.

Please visit our Diagnosis toolkit page for more information.

aThe diagnosis toolkit available at IBSCounSEL.com has not been validated in clinical trials

A multidisciplinary approach to the management of IBS

A multidisciplinary approach to the management of patients with IBS is becoming increasingly popular. Such an integrated approach could involve a team of healthcare professionals comprising the primary care physician, a consultant gastroenterologist, psychologist, psychiatrist, nutritionist, or dietician, and a nurse practitioner.4 Dietary modifications, psychological therapies, and pharmacological therapies have all been assessed as beneficial in the management of IBS. While IBS is often diagnosed and can be managed in the primary care setting, referral for psychological treatment may be recommended as part of a multidisciplinary treatment program to better manage symptoms, especially where psychosocial difficulties may interfere with daily function.5 Additionally, some patients with IBS have lessened their symptoms with elimination diets,6 but this should be avoided in patients with eating disorders,7 so consultation with a registered dietitian may be warranted. Regular communication between all of the healthcare professionals involved in a patient’s symptom management regimen is important for optimal IBS management.8

The IBS CounSEL Management toolkit provides information on a range of management strategies and educational materials to assist with the identification of a suitable treatment plan. Click here for more information.

The microbiome and brain–gut interaction in IBS

There is increasing evidence to suggest that imbalances in gut microbiota play a role in the pathophysiology of some individuals with IBS.9 Recent evidence suggests IBS is associated with an imbalance in enteric bacterial communities, experimental data indicate that gut microbiota can influence brain morphology as well as behavior, mood, and cognition, and small intestinal bacterial overgrowth has also been associated with IBS.10 Treatments targeting the microbiome (prebiotics: food or dietary supplements that result in specific changes in the composition and/or activity of GI microbiota; probiotics: live microorganisms; synbiotics: food or dietary supplements which are a mixture of probiotics and prebiotics; and antibiotics: e.g. rifaximin for the treatment of IBS-D) have demonstrated modest but significant benefits over placebo in IBS symptoms, including abdominal pain and flatulence, although heterogeneous study design and small study populations have precluded a weak recommendation for their use in IBS.6

Further investigations are warranted to determine if the microbiota–gut–brain axis might offer new therapeutic targets in the management of IBS and comorbid conditions.10

To learn more about Rome IV, visit the Rome Foundation website

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References

  1. Lacy BE et al. Gastroenterology 2016; 150: 1393-1407.
  2. Longstreth GF et al. Gastroenterology 2006; 130: 1480-1491.
  3. Vanner SJ et al. Am J Gastroenterol 1999; 94: 2912-2917.
  4. Chang FY. World J Gastroenterol. 2014; 20: 2499-2514.
  5. Ballou S, Keefer L. Clin Transl Gastroenterol 2017; 8: e214.
  6. Ford AC et al. Am J Gastroenterol 2018; 113: 1-18.
  7. Chey WD. Am J Gastroenterol 2019; 4: 201-203.
  8. Patel S et al. Consultant360 2018. Published online November 27, 2018.
  9. Menees S, Chey W. F1000Res 2018; 7: 1029.
  10. Quigley EMM. J Clin Med 2018; 7: 6.