Doing The Right Thing

Medical Author: Jay W. Marks, M.D.

Irritable Bowel Syndrome I often am asked by other physicians to assist with their patients who have difficult-to-diagnose gastrointestinal problems. Many of these patients are suspected of having irritable bowel syndrome (IBS). Since there is no specific test for IBS, the diagnosis of IBS is made by recognizing a grouping of characteristic symptoms and excluding diseases that can mimic IBS. The issue always arises as to what constitutes complete testing in order to exclude diseases other than IBS. Not all patients thought to have IBS require complete testing. The patients who do are those with moderate or severe symptoms that do not respond sufficiently to simple and safe treatments. When the generalist (family practice physician or internist) is unable to make a diagnosis and/or recommend other treatment, it is time for the patient to see a specialist, a gastroenterologist.

A detailed medical history that is taken by a knowledgeable, experienced, and interested physician is the single most important "test" for IBS. It may be necessary to ask patients to return for further history-taking after instructing them to make additional observations about their symptoms. The goal is to find consistent patterns of symptoms. By the time a thorough history has been obtained, the physician usually will have a good idea of whether IBS or another disease is present. For example, intermittent obstruction of the small bowel (a common problem) causes symptoms that are similar to IBS. However, there is a difference between the sequence and timing of symptoms in small bowel obstruction and IBS. If a disease other than IBS is suspected, specific testing for that disease should be performed.