For more information visit us at Dr Simon Smale our Consultant Gastroenterologist follows on from his brief overview of …
Hello,
Simon Smale, consultant gastroenterologist,
I thought today in the light of the
fact that I feel the sound quality of my
original IBS videos was poor I would
repeat some of those and i'm going to talk initially about irritable bowel syndrome
and its diagnosis and how a
gastroenterologist or a general
practitioner might reach positive
diagnosis of irritable bowel syndrome
which I think is very important in terms
of going forwards and having to manage
that diagnosis constructively. In
terms of making the diagnosis the
current guidance suggests that the
patient should of have had at least six
months of abdominal pain or discomfort
associated with bloating at times
although not always and similarly there
may well also be a change in bowel habit
which is another feature. Now in terms of
those symptoms
clearly they are symptoms which are
presentations of many gastrointestinal
diseases and so it's important first
of all that the chronicity is there in other words
that it's been there for a long time
more than three months at least
secondly there are a number of things
which might raise flags red flags and
and make us seek further investigation
those are weight loss , unintentional
unexplained weight loss should always
give doctors consideration of further
investigations
similarly rectal bleeding whilst being a
common condition is sometimes a sign of
more sinister pathology and therefore
consideration should be given to further
investigation
it's not always necessary and sometimes
the type of rectal bleeding makes clear
what the likely cause is usually a
problem with the anal canal
but sometimes that rectal bleeding can reflect more sinister problems. A family
history particularly in people who are reaching an age where cancer is more common of
either colon or ovarian cancer and that
should lead at least consideration of
whether further investigation should be
indicated and lastly and if people over
sixty have new symptoms that have been going on for lesson than six weeks that clearly needs
further investigation and some people
would argue that the cut off of sixty
is perhaps a little old but that's what the
current guidance suggests so in terms of
Investigation obviously everyone should be examined and they should be examined to
make sure they don't have any abdominal
masses that doctor should feel
somebody's tummy or the practitioner
equally people should have a rectal
examination to make sure they don't have
any lumps or bumps in the inside of
their rectum and lastly people shouldn't
be anaemic people shouldn't have anaemia
in irritable bowel syndrome at least
unless they have another cause for it
which has already been diagnosed. In terms of Investigations everybody diagnosed
with irritable bowel syndrome before
they reach that diagnosis definitively
should have a normal full blood count and either a normal ESR or CRP which are markers of
inflammation in the body now usually unless there are obviously any other inflammatory
conditions going on in the body
irritable bowel syndrome doesn't cause a
raised ESR or CRP and everyone should have a negative celiac serology, that's a blood test
sometimes available as just finger prick
test these days but that's not
universally available and that tells the
patient whether or not they're allergic
to a component of wheat called gluten
it is a small fragment of the gluten
which people become allergic and if all of
those tests are negative then we can
make positive diagnosis of irritable
bowel syndrome the nice guidance
suggests a number of tests aren't
indicated that unless there are features
that perhaps suggest another diagnosis so ultrasound, unless people have got
symptoms of gallstones with right upper
abdominal pain after eating associated
with nausea and vomiting very often people don't require an ultrasound
Similarly if people have got classical
symptoms of abdominal pain and changing
bowel habit over many months often
years and that's gone on for some time
in their tests are normal as we've
discussed then they don't need a
colonoscopy or sigmoidoscopy similarly
they don't need thyroid function tests and
unless there are other features of
overactive thyroid nor do they need
stool cultures because they're very few
infectious causes of diarrhea that go on
for six months or more with those positive features in the story so abdominal pain
bloating and bowel habit and a normal or
negative examination and those normal
investigations that we've touched on
full-blood count, inflammatory markers and
celiac screen we can be confident that we
have made a positive diagnosis of irritable
bowel syndrome
some people would do a fecal
calprotectin which is a stool test for
inflammatory markers and if they're features of weight loss sometimes, or a deficiency in
vitamins, a fecal elastase but those are
tests which are kind of extra and
specialist not necessarily indicated in
people with the classic story of IBS
where one can make a really positive
diagnosis based upon the history and
examination findings along with those
standard investigations
thanks for listening

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