All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Diagnosis of irritable bowel syndrome
Medical expert of the article
Last reviewed: 04.07.2025
Irritable bowel syndrome is a diagnosis of exclusion. For children, symptoms that exclude the diagnosis of irritable bowel syndrome include unexplained weight loss, persistence of symptoms at night (during sleep), persistent severe abdominal pain, progression of the condition, fever, rectal bleeding, painless diarrhea, steatorrhea, lactose, fructose and gluten intolerance, changes in laboratory parameters (Rome Criteria III, 2006).
Organic bowel diseases are excluded - polyposis, diverticulosis, Crohn's disease and non-specific ulcerative colitis, intestinal and parasitic infections, short small bowel syndrome, dolichosigma, tuberculosis. The initial stages of neuroendocrine tumors of the gastrointestinal tract (gastrinomas, carcinoid syndrome and vipomas) can occur under the guise of diarrheal or painful form of irritable bowel syndrome. Thyrotoxicosis and diabetes mellitus with autonomous diabetic enteropathy sometimes occur in the tint of the diarrheal form of irritable bowel syndrome.
Food and medications can irritate the intestines. The most common food triggers are fatty foods, coffee, gas-forming foods and drinks, large meals, changes in habitual diet, and alcoholic beverages. Among medications, antibiotics, laxatives, senna, iron, and bile acid preparations have an irritating effect on the intestines.
Premenstrual period, prolonged psycho-emotional and intellectual stress, fear, anxiety can lead to the development of signs of irritable bowel syndrome, which quickly disappear after rest and resolution of the stressful situation. "Bear disease" can be considered as a form of irritable bowel syndrome.
Algorithm for diagnosing irritable bowel syndrome
The non-specificity of the clinical picture of intestinal damage makes it extremely difficult to establish a diagnosis at the nosological level. It is much easier to determine the formed pathological syndromes and begin symptomatic treatment.
The diagnostic algorithm consists of 5 stages.
- Making a preliminary diagnosis.
- Identification of the dominant symptom and its clinical form of syndrome.
- Exclusion of clinical symptoms according to Rome III criteria (2006) that do not correspond to the diagnosis of irritable bowel syndrome, conducting differential diagnostics.
- Exclusion of organic disease by performing diagnostic tests (clinical and biochemical blood tests, coprological examination, stool analysis for helminth eggs, esophagogastroduodenoscopy, ultrasound of the abdominal cavity and pelvic organs, sigmoidoscopy or colonoscopy, irrigoscopy).
- Prescribing a primary course of treatment for a period of 6 weeks, monitoring the adequacy of the diagnosis taking into account the treatment results.
If the treatment is effective, a final diagnosis of irritable bowel syndrome is made; if it is ineffective, additional examination is necessary.
[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ]