According to Rome II criteria, irritable bowel syndrome is defined as a group of functional bowel disorders in which abdominal discomfort or pain is associated with defecation or change in bowel habit and is associated with features of disordered defecation. A diagnosis is based on identifying the consistent symptoms with the exclusion of other organic or functional disorders having similar clinical presentations in a cost-effective manner. A physical examination should be performed on the first visit and on subsequent visits as needed. Two algorithms for the evaluation of patients seen in primary care settings and two other algorithms for patients presenting to gastroenterologists are presented. In general, if Rome II criteria are fulfilled, alarm features are not present, and screening studies from the referring physician are negative, further testing is not needed. Screening studies are recommended when certain historical information is present. In many cases, the therapeutic trial can be undertaken before further diagnostic studies are done and will depend on the symptom subtype and its severity. It needs to be emphasized that patients presenting with typical symptoms and no alarm signs are rarely found to have another diagnosis, supporting the benefit of ongoing care and symptomatic management rather than continued diagnostic evaluation. If initial treatment fails, or certain clinical features emerge requiring further evaluation, studies may be performed by gastroenterologists in specialty centers.
Humans ; Irritable Bowel Syndrome/*diagnosis

Humans ; Irritable Bowel Syndrome ; diagnosis ; therapy

Irritable bowel syndrome (IBS) is characterized by abdominal discomfort, bloating and disturbed defecation in the absence of any identifiable physical, radiologic or laboratory abnormalities indicative of organic gastrointestinal disease. Diagnosis is based on the identification of symptoms according to Manning, Rome I and Rome II criteria and exclusion of alarm indicators. Approximately, 10-20% of the general population has IBS, and it affects female more often than male for unexplained pathophysiologic reasons. In Korea, it has been reported that the prevalence of IBS is 2.2-6.6% by Rome II criteria and 22.3% by Manning criteria. The health care-seeking population was only 28.6% of community population. Although most patients do not seek medical help, the disease accounts for huge costs for both patients and health-care systems and worsens patients' quality of life significantly.
Humans ; *Irritable Bowel Syndrome/diagnosis/epidemiology ; Korea/epidemiology

No abstract available.
Female ; Gastroenteritis/*complications ; Humans ; Irritable Bowel Syndrome/*diagnosis ; Male

Migraine is a primary episodic headache disorder that represents a substantial burden and disability worldwide. Its pathogenesis is multifactorial and remains hitherto poorly elucidated. An interesting but less-well-known association is that between migraine and gastrointestinal disorders. We have reviewed the literature for relevant papers reporting on the clinical association between migraine and gastrointestinal symptoms. Several studies have shown different gastrointestinal diseases to be associated with migraine, but the underlining pathophysiology remains elusive. The data gathered and analyzed have shown great variability across studies, making it impossible to draw definitive conclusions. Further research is required to elucidate this potential relationship. An understanding of the relationship between migraine and gastrointestinal disorders is of great clinical importance for prompt diagnosis and treatment.
Diagnosis ; Gastrointestinal Diseases ; Headache ; Headache Disorders ; Inflammatory Bowel Diseases ; Irritable Bowel Syndrome ; Migraine Disorders*

No abstract availble.
Colonic Diseases, Functional/diagnosis/physiopathology ; Humans ; *Irritable Bowel Syndrome/diagnosis/physiopathology

BACKGROUND/AIMS: Several studies have found that the measurement of fecal calprotectin is useful for the early diagnosis of inflammatory bowel disease (IBD). We compared the effectiveness of three different fecal calprotectin kits for initial diagnosis in patients with suspected IBD. METHODS: We enrolled 31 patients with IBD (18 Crohn's disease [CD], 11 ulcerative colitis [UC], and two intestinal Behçet's disease), five with irritable bowel syndrome (IBS), and five with other colitis (four infectious colitis and one intestinal tuberculosis). Diagnosis was based on clinical, laboratory, and endoscopic examinations. Fecal samples were obtained at the first diagnosis and calprotectin levels were measured using three different kits (Quantum Blue® Calprotectin, EliA™ Calprotectin, and RIDASCREEN® Calprotectin). RESULTS: The overall accuracy for differentiating IBD from IBS or other colitis was 94% and 91%, respectively, for Quantum Blue® (cutoff, 50 µg/g); 92% and 89%, respectively, for EliA™ (cutoff, 50 µg/g); and 82% and 76%, respectively, for RIDASCREEN® (cutoff, 50 µg/g). In patients with CD, the results of Quantum Blue® Calprotectin and EliA™ Calprotectin correlated significantly with levels of the Crohn's disease activity index (Spearman's rank correlation coefficient, r=0.66 and r=0.49, respectively). In patients with UC, the results of EliA™ Calprotectin correlated significantly with the Mayo score (r=0.70). CONCLUSIONS: Fecal calprotectin measurement is useful for the identification of IBD. The overall accuracies of the three fecal calprotectin kits are comparable.
Colitis ; Colitis, Ulcerative ; Crohn Disease ; Diagnosis* ; Early Diagnosis ; Humans ; Inflammatory Bowel Diseases* ; Irritable Bowel Syndrome ; Leukocyte L1 Antigen Complex*

BACKGROUND/AIMS: Several studies have found that the measurement of fecal calprotectin is useful for the early diagnosis of inflammatory bowel disease (IBD). We compared the effectiveness of three different fecal calprotectin kits for initial diagnosis in patients with suspected IBD. METHODS: We enrolled 31 patients with IBD (18 Crohn's disease [CD], 11 ulcerative colitis [UC], and two intestinal Behçet's disease), five with irritable bowel syndrome (IBS), and five with other colitis (four infectious colitis and one intestinal tuberculosis). Diagnosis was based on clinical, laboratory, and endoscopic examinations. Fecal samples were obtained at the first diagnosis and calprotectin levels were measured using three different kits (Quantum Blue® Calprotectin, EliA™ Calprotectin, and RIDASCREEN® Calprotectin). RESULTS: The overall accuracy for differentiating IBD from IBS or other colitis was 94% and 91%, respectively, for Quantum Blue® (cutoff, 50 µg/g); 92% and 89%, respectively, for EliA™ (cutoff, 50 µg/g); and 82% and 76%, respectively, for RIDASCREEN® (cutoff, 50 µg/g). In patients with CD, the results of Quantum Blue® Calprotectin and EliA™ Calprotectin correlated significantly with levels of the Crohn's disease activity index (Spearman's rank correlation coefficient, r=0.66 and r=0.49, respectively). In patients with UC, the results of EliA™ Calprotectin correlated significantly with the Mayo score (r=0.70). CONCLUSIONS: Fecal calprotectin measurement is useful for the identification of IBD. The overall accuracies of the three fecal calprotectin kits are comparable.
Colitis ; Colitis, Ulcerative ; Crohn Disease ; Diagnosis* ; Early Diagnosis ; Humans ; Inflammatory Bowel Diseases* ; Irritable Bowel Syndrome ; Leukocyte L1 Antigen Complex*

Functional gastrointestinal disorders (FGIDs) are diagnosed and classified using the Rome criteria; the criteria may change over time as new scientific data emerge. The Rome IV was released in May 2016. The aim is to review the main changes in Rome IV. FGIDs are now called disorders of gut-brain interaction (DGBI). Rome IV has a multicultural rather than a Western-culture focus. There are new chapters including multicultural, age-gender-women’s health, intestinal microenvironment, biopsychosocial, and centrally mediated disorders. New disorders have been included although not truly FGIDs, but fit the new definition of DGBI including opioid-induced gastrointestinal hyperalgesia, opioid-induced constipation, and cannabinoid hyperemesis. Also, new FGIDs based on available evidence including reflux hypersensitivity and centrally mediated abdominal pain syndrome. Using a normative survey to determine the frequency of normal bowel symptoms in the general population changes in the time frame for diagnosis were introduced. For irritable bowel syndrome (IBS) only pain is required and discomfort was eliminated because it is non-specific, having different meanings in different languages. Pain is now related to bowel movements rather than just improving with bowel movements (ie, can get worse with bowel movement). Functional bowel disorders (functional diarrhea, functional constipation, IBS with predominant diarrhea [IBS-D], IBS with predominant constipation [IBS-C], and IBS with mixed bowel habits) are considered to be on a continuum rather than as independent entities. Clinical applications such as diagnostic algorithms and the Multidimensional Clinical Profile have been updated. The new Rome IV iteration is evidence-based, multicultural oriented and with clinical applications. As new evidence become available, future updates are expected.
Abdominal Pain ; Constipation ; Diagnosis ; Diarrhea ; Gastrointestinal Diseases ; Hyperalgesia ; Hypersensitivity ; Irritable Bowel Syndrome

A tight link exists between dietary factors and irritable bowel syndrome (IBS), one of the most common functional syndromes, characterized by abdominal pain/discomfort, bloating and alternating bowel habits. Amongst the variety of foods potentially evoking "food sensitivity", gluten and other wheat proteins including amylase trypsin inhibitors represent the culprits that recently have drawn the attention of the scientific community. Therefore, a newly emerging condition termed non-celiac gluten sensitivity (NCGS) or non-celiac wheat sensitivity (NCWS) is now well established in the clinical practice. Notably, patients with NCGS/NCWS have symptoms that mimic those present in IBS. The mechanisms by which gluten or other wheat proteins trigger symptoms are poorly understood and the lack of specific biomarkers hampers diagnosis of this condition. The present review aimed at providing an update to physicians and scientists regarding the following main topics: the experimental and clinical evidence on the role of gluten/wheat in IBS; how to diagnose patients with functional symptoms attributable to gluten/wheat sensitivity; the importance of double-blind placebo controlled cross-over trials as confirmatory assays of gluten/wheat sensitivity; and finally, dietary measures for gluten/wheat sensitive patients. The analysis of current evidence proposes that gluten/wheat sensitivity can indeed represent a subset of the broad spectrum of patients with a clinical presentation of IBS.
Amylases ; Biomarkers ; Cross-Over Studies ; Diagnosis ; Glutens* ; Humans ; Irritable Bowel Syndrome* ; Triticum ; Trypsin Inhibitors