Irritable bowel syndrome 255
Answers CASE 8.22 – Abdominal bloating. Q1: What is the likely differential diagnosis? A1 IBS Bacterial overgrowth, lactose intolerance or IBD.
Q2: What in the given history supports the diagnosis? A2 Bacterial overgrowth, lactose intolerance and IBS can be difficult to separate from history alone. However, if the patient reports that certain foods (milk based) exacerbated symptoms and there is diarrhoea at the same time, lactose intolerance is a possibility. Bacterial overgrowth can mimic this. If the patient experiences relief of abdominal pain with passing flatus or faeces, it is likely to be IBS, particularly if the symptoms are episodic.
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Q3: What additional features in the history would you seek to support a particular diagnosis?
A3 It is important to look for duration of the illness. Irritable bowel syndrome often has insidious onset for many months before patients seek help. Weight gain is often the case, although weight loss might be a consequence of stress. Weight loss is, however, more likely to indicate organic disorder such as IBD or coeliac disease. Abdominal pain that is worse on the day that the stool form is different suggests IBS. Straining to finish defecation is often found with IBS patients, as is mucus. No blood should be present.
Q4: What clinical examination would you perform and why? A4 On examination there should be no abnormal findings. In IBD, tenderness, abdominal mass or perianal abnormalities may be found.