Irritable Bowel Syndrome Case Studies

Irritable bowel syndrome (IBS) is a widespread gastrointestinal (GI) illness that is classified as a "functional" GI condition because there are complications with normal gut function; however, no distinguishable causes describe its development. An association has been discovered between abnormalities in GI tract motility, variations in autonomic regulation, sensitivity in abdominal viscera, brain-gut communication abnormalities, and changes within the GI flora. Abdominal bloating, flatulence, abdominal pain, and bowel dysfunction describe IBS. IBS has been described as abdominal discomfort associated with altered bowel patterns and symptoms of constipation, including irregular stools, straining, passage of hard stools, and feelings of incomplete or difficult evacuation. Symptoms usually have an onset in late adolescence to early adulthood; peak incidence occurs in the third and fourth decades of life. Characteristics that support the diagnosis of IBS include abnormal stool passage (straining, urgency, or feeling of incomplete evacuation), passage of mucus, and bloating or feeling of abdominal distention. Abdominal pain must be present for a diagnosis of IBS. The pain related to IBS is typically described as
nonradiating, intermittent, crampy pain in the lower abdomen (most commonly, the left lower quadrant). Diagnosis is confirmed with abdominal discomfort or pain with two or more of the following features: improvement with defecation, onset associated with change in frequency of stool (less than three bowel movements per week or more than three bowel movements per day), onset associated with change in appearance of stool (lumpy/hard or loose/watery) or, one or more of the following symptoms: abnormal stool frequency (< 3/week), abnormal stool passage (straining, incomplete or difficult evacuation), abnormal stool form (hard, lumpy), feeling of bloating or abdominal distention, expelling mucus in stool, and frequent, loose stools.
These symptoms must be present in the previous six months of diagnosis, at least three days per month in the past three
months. For confirmation of diagnosis, laboratory tests needed includes CBC with differential, ESR, serum electrolytes, BUN, creatinine, glucose, TSH, stool for occult blood and fecal leukocytes (if fecal leukocytes are present, test for enteric pathogens, ova and parasites, and C. difficile), LFTs, serum transglutaminase antibody, Hydrogen breath test, and celiac blood panel. Radiology testing recommended for diagnosis include KUB (flat plate and upright), barium enema, and abdominal ultrasound.