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Irritable bowel syndrome is the most commonly diagnosed gastroenterologic condition, accounting for a substantial number of physician visits in both gastroenterology and primary care practices. The prevalence in North America is estimated to be 11.8%.1 Patients with IBS most commonly have irregular bowel habits in conjunction with abdominal pain or discomfort. The Rome III diagnostic criteria for IBS require the presence of recurrent abdominal pain or discomfort for at least 3 days per month during the last 3 months with onset of more than 6 months prior.2 These symptoms must also be associated with 2 or more of the following: improvement with defecation, change in stool frequency, or change in stool appearance or form. Irritable bowel syndrome is typically considered a diagnosis of exclusion, requiring initial evaluation for organic or structural causes, especially in the setting of symptom onset after age 50 years, unexplained iron deficiency anemia, rectal bleeding, weight loss, or nocturnal abdominal pain.3 All patients with suspected IBS should undergo colorectal cancer screening as dictated by their age and risk factors and a complete blood cell count. In patients with diarrhea, testing for celiac disease as well as colonoscopy with random biopsies should be considered. Obtaining serum or stool inflammatory marker measurements such as C-reactive protein or fecal calprotectin may also be part of the initial evaluation as well.4
Rao VL, Cifu AS, Yang LW. Pharmacologic Management of Irritable Bowel Syndrome. JAMA. 2015;314(24):2684–2685. doi:10.1001/jama.2015.16943
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