When Irritable Bowel is not Irritable Bowel Syndrome (IBS)

Had patient in today with dark blood stools previously diagnosed with Irritable bowel but more much likely now colitis. Had another case recently worked up by a gastroenterologist with nothing organic found – yet fact subject eats  a lot of fruit was not factored in.

1/6 IBS cases have something significant even with out warning features -causes: crohn’s,  celiac, and microscopic colitis. Then there is the fructose malabsorption that will be more apparent this summer with increased fruit consumption.

Scand J Gastroenterol. 2015 Jul;50(7):816-23. doi: 10.3109/00365521.2015.1007079.
Prevalence of organic disease at colonoscopy in patients with symptoms compatible
with irritable bowel syndrome: cross-sectional survey.
Patel P(1), Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P, Ford
AC.
http://www.ncbi.nlm.nih.gov/pubmed/25636675

  • 136 Irritable bowel cases with “No alarm features”
  • 15.4% pathology though if diarrhea based was 32.1%, mixed 23.8% and constipation 12.7%
  •  7.4% Crohn’s disease
  • 2.9% coeliac disease
  • 2.2% microscopic colitis

Eur J Gastroenterol Hepatol. 2015 Jul;27(7):785-96.
doi:10.1097/MEG.0000000000000374
Effects of dietary education, followed by a tailored fructose-restricted diet in
adults with fructose malabsorption.
Bonfrate L(1), Krawczyk M, Lembo A, Grattagliano I, Lammert F, Portincasa P.
http://www.ncbi.nlm.nih.gov/pubmed/25919770

  • abdominal pain, bloating, and diarrhea symptoms
  • deficiency of the hepatic aldolase B enzyme
  • of 679 gastointestinal symptom cases, 146 cases were found fructose intolerant
  • fructose restriction significantly improved GI symptoms

Comment – It has been suggested without warning features patient should be just told it is IBS. Obviously that is wrong. What is worse are subjects with prior Crohn’s told it is now IBS because no inflammation could be seen – when actually secretions suggest otherwise:

Prior Crohn’s or Ulcerative Colitis and Now Told You have an Irritable Bowel – That’s a Bum Rap- Signs of Inflammation Persist
http://painmuse.org/?p=374

Suggests need for better workups.

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