<<Disclaimer: Verify this information before applying it to your situation.>>

Saw this in Medscape today (which is free to you if you register)

I think it would be a great idea to copy and give to your family physicians
and any other health care people you come in contact with.  Looks like we
are making headway!


beginning of article:

http://www.medscape.com/viewarticle/461605?mpid=18971

straight to page 2:

http://www.medscape.com/viewarticle/461605_2


Recommended Diagnostic Evaluation of Patients With Suspected IBS
The differential diagnosis of a patient initially presenting with symptoms
diagnostic of IBS is extensive and includes a number of gastrointestinal
disease processes, such as inflammatory bowel disease, colorectal
neoplasia, gluten-sensitive enteropathy, chronic giardiasis, etc. Because
of the possibility that these or other potentially serious diseases could
masquerade as IBS, many experts have recommended a wide variety of
diagnostic tests be performed in patients fulfilling the symptom criteria
for IBS before a definitive diagnosis of IBS is made (ie, IBS is a
diagnosis of exclusion, not inclusion). Examples of some of these tests
routinely recommended in a patient with suspected IBS include a complete
blood count and erythrocyte sedimentation rate, stool studies for ova and
parasites, sigmoidoscopy with rectal biopsy and/or a barium enema or
colonoscopy, a small bowel study, chemistry panels, thyroid function tests,
sprue antibodies, and a host of other "screening" tests.[5-9]

However, before embarking on a search for other potential disease states in
a patient thought to have IBS, the clinician needs to know the likelihood
or possibility that disease could be present in a patient presenting with
these symptoms -- that is, what is the pretest possibility of that disease
being present?[1] A number of studies have assessed the prevalence of other
gastrointestinal diseases in patients fulfilling the above symptom-based
diagnostic criteria for IBS.[5-10] There are a number of limitations to
these studies, but despite this deficiency, a central theme exists in all
of these data: there are still no data that support the routine performance
of any diagnostic test in patients fulfilling the symptom criteria for IBS.
The exception to this conclusion is the suggestion from a single study that
celiac sprue may be more prevalent in a suspected IBS population, and this
observation may then support the use of screening antibody tests for sprue
when such possibility
 exists.[10]

An important caveat to the current recommendation to not perform any
further diagnostic testing in patients with suspected IBS is that patients
with symptoms of IBS who also present with any of the "so-called" alarm
symptoms (fever, anemia, weight loss, rectal bleeding) may have a greater
likelihood of other pathology, and in these select few patients, additional
organ-specific testing may be appropriate and is still recommended.[1] This
is especially true for older patients (> 50 years of age), in whom
colorectal neoplasia has to be considered as a possibility for those
presenting with new bowel symptoms or new alarm symptoms.



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