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Diagnosis of irritable bowel syndrome
Last reviewed: 23.04.2024
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Irritable bowel syndrome is the diagnosis of an exception. For children, symptoms that exclude the diagnosis of irritable bowel syndrome are unmotivated weight loss, persisting symptoms at night (during sleep), persistent intense abdominal pain, progression of the condition, fever, rectal bleeding, painless diarrhea, steatori, lactose intolerance, fructose and gluten, changes in laboratory parameters (Roman criteria III, 2006).
Exclude organic diseases of the intestines - polyposis, diverticulosis, Crohn's disease and ulcerative colitis, intestinal and parasitic infections, small intestine syndrome, dolichosigma, tuberculosis. The initial stages of neuroendocrine tumors of the gastrointestinal tract (gastrinomas, carcinoid syndrome and vipomes) can occur under the mask of a diarrheal or painful form of irritable bowel syndrome. Thyrotoxicosis and diabetes mellitus with autonomic diabetic enteropathy sometimes occur according to the type of diarrheal form of irritable bowel syndrome.
Food products and medications can cause irritation of the intestine. The most common food provocators are fatty foods, coffee, gas-producing foods and drinks, plentiful food, changes in habitual food, alcohol-containing drinks. Among drugs, antibiotics, laxatives, have an irritant effect on the intestines. Preparations of senna, iron and bile acids.
The premenstrual period, prolonged psychoemotional and intellectual tension, fright, excitement can lead to the development of signs of irritable bowel syndrome, rapidly disappearing after rest and resolution of a stressful situation. As a form of irritable bowel syndrome, you can consider "bear illness".
Algorithm for the diagnosis of irritable bowel syndrome
Nonspecific clinical picture of bowel disease makes it extremely difficult to diagnose at the nosological level. It is much easier to determine the formed pathological syndromes and to begin symptomatic treatment.
The diagnostic algorithm consists of 5 stages.
- Preliminary diagnosis.
- Isolation of the dominant symptom and its clinical form of the syndrome.
- Exclusion of clinical symptoms according to Roman criteria III (2006), which do not correspond to the diagnosis of irritable bowel syndrome, differential diagnosis.
- Elimination of organic disease by performing diagnostic tests (clinical and biochemical blood tests, coprological examination, feces analysis for egg worms, esophagogastroduodenoscopy, ultrasound of the abdominal cavity and pelvis, sigmoid or colonoscopy, irrigation).
- The appointment of an initial course of treatment for a period of 6 weeks, monitoring the adequacy of the diagnosis, taking into account the results of treatment.
When the effectiveness of treatment is put the final diagnosis of irritable bowel syndrome, if ineffectiveness requires additional examination.
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