Diagnostic Approach and Management of Irritable Bowel Syndrome

Key Diagnostic Features and Red Flags

The American Gastroenterological Association recommends that patients with symptoms of irritable bowel syndrome (IBS) meet the Rome IV criteria for functional abdominal bloating and distension, which includes colicky abdominal pain and abdominal distension and flatulence as supportive symptoms 1
The World Journal of Emergency Surgery suggests that before confirming IBS, it is essential to exclude conditions such as mechanical obstruction, which can be done by checking for the absence of key features like vomiting, absence of flatus, and absence of bowel movements 2, 3
The presence of abdominal distension and colicky pain without constipation, diarrhea, or vomiting in a 35-year-old female is consistent with the bloating-predominant subtype of IBS, according to the Gastroenterology journal 1

The Clinical Gastroenterology and Hepatology journal recommends ordering a complete blood count to rule out anemia or infection, and considering fecal calprotectin testing to exclude inflammatory bowel disease 1, 6
The World Journal of Emergency Surgery suggests that a plain abdominal radiograph during an acute episode can help exclude bowel obstruction and other abdominal pathology 2
The Gut journal recommends considering small intestinal bacterial overgrowth (SIBO) if flatulence and bloating are prominent, and testing with hydrogen breath testing if symptoms persist despite initial management 6, 7

The American Gastroenterological Association recommends a first-line therapeutic approach that includes dietary modification with a low FODMAP diet, antispasmodic medication for colicky abdominal pain, and education and reassurance 1, 6
The Clinical Gastroenterology and Hepatology journal suggests considering probiotics, neuromodulators, and psychological therapies as second-line options if initial treatment fails 6
The Gastroenterology journal recommends performing colonoscopy or sigmoidoscopy if the patient is over 50 years old, or if clinical features suggestive of organic disease develop 1