Hopefully this post will help explain it and the actual diagnoses of IBS itself. There are some major misunderstanding about diagnosing IBS, the term IBS- a distint enity- A lower GI disorder of function. And people's frustration and looking for all the things that could cause it. However, some have already been ruled out, some important ones are being researched and some DON"T apply to begin with.
You can read it or not. But I hope it really helps some people. I will continue to add information to it, so its not all at once.
First its important to go over IBS itself. There are some 28 GI disorders of function, some examples are IBS, functional dyspepsisa, functional D, functional c, functional analrectal disorders ect..
The diagnoses of IBS is based on a specific cluster of symptoms. It is NOT a catch all diagnoses.
"What Patients Know About Irritable Bowel Syndrome (IBS) and What They Would Like to Know. National Survey on Patient Educational Needs in IBS and Development and Validation of the Patient Educational
Posted 09/18/2007
"The most prevalent IBS misconceptions included (% of subjects agreeing with the statement): IBS is caused by lack of digestive enzymes (52%), is a form of colitis (42.8%), will worsen with age (47.9%), and can develop into colitis (43%) or malnutrition (37.7%) or cancer (21.4%). IBS patients were interested in learning about (% of subjects choosing an item): (1) foods to avoid (63.3%), (2) causes of IBS (62%), (3) coping strategies (59.4%), (4) medications (55.2%), (5) will they have to live with IBS for life (51.6%), and (6) research studies (48.6%). Patients using the Web were better informed about IBS.
Conclusion: (1) Many patients hold misconceptions about IBS being caused by dietary habits, developing into cancer, colitis, causing malnutrition, or worsening with age; (2) patients most often seek information about dietary changes; and (3) educational needs may be different for persons using the internet for medical information."
"The emerging research typifies IBS as a brain-gut disorder where psychosocial factors (e.g., stress, cognitions, coping, etc.) can alter the symptoms and illness experience for better or worse. Due to these and other disease specific characteristics, that are amenable to education, we believe effective educational interventions may significantly impact the management of this common disorder."
Patients Consider IBS a Diagnosis of Exclusion: Over 50% of the patients considered IBS to be a "catch all" diagnosis and another 22% were unsure. While this could reflect the information provided by their physicians (thus highlighting the need to also educate physicians about IBS), this misconception may motivate patients to seek more and more diagnostic studies to find "the cause." The use of the Rome criteria[17] permits the patient to have a positive diagnosis. With confidence in knowing that IBS is a specific entity , such behaviors are minimized. Thus it is important for the physician to provide proper education about the level of confidence in the diagnosis.
http://www3.interscience.wiley.com/journal/117956426/abstract?CRETRY=1&SRETRY=0
Hopefully also it will help when talking to your doctor.
NEVER self diagnose. The leading cause of misdiagnoses is self diagnoses. Some conditions that mimick some IBS symptoms are also very serious and even potentially deadly.
First though is the change in diagnosing IBS that has been made.
"In the past two decades, medical opinion has changed regarding how to diagnose IBS. The older view emphasized that IBS should be regarded primarily as a "diagnosis of exclusion;" that is, diagnosed only after diagnostic testing excludes many disorders that could possibly cause the symptoms. Because many medical disorders can produce the cardinal IBS features of abdominal discomfort or pain and disturbed bowel habit as well as other symptoms caused by IBS, this approach often led to extensive diagnostic testing in many patients. Since the era when such thinking about IBS was common, laboratory, motility, radiologic, and endoscopic tests have proliferated. Although each of these tests is useful in evaluating certain problems, their routine or indiscriminate use can cause unnecessary inconvenience and cost for patients, and complications even occur infrequently from some of the tests. Fortunately, physicians can now diagnose IBS in most patients by recognizing certain symptom details, performing a physical examination, and undertaking limited diagnostic testing. This simpler approach is grounded on recent knowledge of the typical symptoms of IBS, and it leads to a reliable diagnosis in most cases. Extensive testing is usually reserved for special situations."
http://www.aboutibs.org/Publications/diagnosis.html
Diagnosis
Patients with IBS can be confidently and correctly diagnosed using the Rome criteria in conjunction with a complete history and thorough physical examination (reviewed by Lacy and De Lee The utility of routine laboratory testing is widely debated, however, especially in those presumed IBS patients with diarrhea predominance, because of concern regarding the possibility of missing the diagnosis of celiac disease or inflammatory bowel disease (IBD). During ACG 2006, studies were presented that evaluated the utility of tests commonly ordered in the evaluation of some IBS patients. Two separate studies[27,28] reported on the diagnostic accuracy of serologic markers for celiac disease and IBD in a prospective, multicenter, observational trial involving 323 patients with IBS symptoms (mean age = 39 years; 68% women) and 241 controls referred for routine colon cancer screening (mean age = 54 years; 43% women). Routine laboratory tests (complete blood count, thyroid-stimulating hormone, and electrolytes), testing for specialized IBD serologic markers (antineutrophil cytoplasmic antibodies, IgA, and IgG anti-Saccharomyces cerevisae antibodies, and anti-OmpC antibodies [outer membrane porin to Escherichia coli]), serologic tests for celiac disease (anti-gliadin, anti-endomysial, anti-tissue transglutaminase antibodies), and colonoscopy were performed in all patients. Patients with serologic evidence of celiac disease also underwent upper endoscopy with biopsies of the small intestine. In this large group of subjects, only 2 patients with IBS symptoms were diagnosed with IBD. In fact, IBD serologic markers had a false-positive rate of 30%, and this finding was similar in both control and IBS patients. Tests for celiac disease were more frequently positive in IBS patients (7.4%) than in controls (2.9%); however, biopsies confirmed the diagnosis of celiac disease in just 1.24% of IBS patients and 0.8% of controls. No single antibody test for celiac disease identified all patients with biopsy-proven celiac disease. This large, ongoing prospective study demonstrates that celiac disease is uncommon in patients with IBS, that no single antibody test can accurately diagnose all patients with celiac disease, and that serologic tests for IBD have a high false-positive rate. Testing for these disorders should thus be limited to those IBS patients with persistent symptoms who fail to respond to standard therapy and should not be routinely performed in all IBS patients.Two other studies presented during this meeting that discussed testing in IBS patients warrant mention. In the first of these studies, Whitlock and colleagues[29] measured lactoferrin, a marker of activated neutrophils, in stool specimens from 94 IBD patients, 22 IBS patients, and 27 healthy controls (mean age, race, and sex breakdown not provided). Although raw data were not included, the study authors reported that fecal lactoferrin differentiated active IBD from IBS patients and healthy controls with 100% sensitivity and specificity. In addition, the test appeared to be highly accurate in differentiating active IBD patients from inactive IBD patients. These preliminary results are very interesting and warrant confirmation in a multicenter, prospective trial. In the second study,
http://www.medscape.com/viewarticle/547772
Celiac disease is one of the conditions they are looking at in regards to a misdiagnoses.
However Celiac is NOT IBS and it has symptoms such as weight loss and other symptoms that can differentiate for IBS, by a knowledeable doctor.
Celiac does not always cause pain either. It is estimated in about 2 % percent of the population and is still some what underdiagnosed. It also has a close genetic relationship, so if family members have it is could be a very good idea to be screened.
If your looking for very accurate Celiac information this is one of the Doctors.
Dr Green is the Director of The Celiac Disease Center at Columbia University
http://www.celiacdiseasecenter.columbia.ed...3-StaffBios.htm
Further research showed a slightly higher celiac population.
So they are saying now that certain people should be tested for celiac.
Next I will post about the rome criteria hopefully used to diagnosed IBS. Als a little on researchers and the rome criteria and local gi doctors and the rome criteria.
Rome III Journal Articles: Gastroenterology, April 2006
The Rome III book was published in condensed form in a journal supplement that appeared in Gastroenterology (volume 20, issue 5, May 2006) the official journal of the American Gastroenterological Association. The Rome Foundation obtained permission to post the journal articles on our website for download by the American Gastroenterological Association Institute.
Table of Contents
The Functional Gastrointestinal Disorders and the Rome III Process
D. A. Drossman
Fundamentals of Neurogastroenterology: Basic Science
D. Grundy, E. D. Al—Chaer, Q. Aziz, S. M. Collins, M. Ke, Y. Taché, and J. D. Wood
Applied Principles of Neurogastroenterology: Physiology/Motility Sensation
J. E. Kellow, F. Azpiroz, M. Delvaux, G. F. Gebhart, H. R. Mertz, E. M. M. Quigley, and A. J. P. M. Smout
Pharmacological and Pharmacokinetic Aspects of Functional Gastrointestinal Disorders
M. Camilleri, L. Bueno, F. de Ponti, J. Fioramonti, R. B. Lydiard, and J. Tack
Gender, Age, Society, Culture, and the Patient's Perspective in the Functional Gastrointestinal Disorders
L. Chang, B. B. Toner, S. Fukudo, E. Guthrie, G. R. Locke, N. J. Norton, and A. D. Sperber
Psychosocial Aspects of the Functional Gastrointestinal Disorders
R. L. Levy, K. W. Olden, B. D. Naliboff, L. A. Bradley, C. Francisconi, D. A. Drossman, and F. Creed
Functional Esophageal Disorders
J. P. Galmiche, R. E. Clouse, A. Bálint, I. J. Cook, P. J. Kahrilas, W. G. Paterson, and A. J. P. M. Smout
Functional Gastroduodenal Disorders
J. Tack, N. J. Talley, M. Camilleri, G. Holtmann, P. Hu, J.-R. Malagelada, and V. Stanghellini
Functional Bowel Disorders
G. F. Longstreth, W. G. Thompson, W. D. Chey, L. A. Houghton, F. Mearin, and R. C. Spiller
Functional Abdominal Pain Syndrome
R. E. Clouse, E. A. Mayer, Q. Aziz, D. A. Drossman, D. L. Dumitrascu, H. Mönnikes, and B. D. Naliboff
Functional Gallbladder and Sphincter of Oddi Disorders
J. Behar, E. Corazziari, M. Guelrud, W. Hogan, S. Sherman, and J. Toouli
Functional Anorectal Disorders
A. E. Bharucha, A. Wald, P. Enck, and S. Rao
Childhood Functional Gastrointestinal Disorders: Neonate/Toddler
P. E. Hyman, P. J. Milla, M. A. Benninga, G. P. Davidson, D. F. Fleisher, and J. Taminiau
Childhood Functional Gastrointestinal Disorders: Child/Adolescent
A. Rasquin, C. Di Lorenzo, D. Forbes, E. Guiraldes, J. S. Hyams, A. Staiano, and L. S. Walker
Design of Treatment Trials for Functional Gastrointestinal Disorders
E. J. Irvine, W. E. Whitehead, W. D. Chey, K. Matsueda, M. Shaw, N. J. Talley, and S. J. O. Veldhuyzen van Zanten
The Road to Rome
W. G. Thompson
http://www.romecriteria.org/rome_III_gastro/
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My website on IBS is www.ibshealth.com
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