<<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. --------------------------------- Do you Yahoo!? The New Yahoo! Shopping - with improved product search *Support summarization of posts, reply to the SENDER not the CELIAC List*