![]() These include: IBS with constipation, IBS with diarrhea, IBS with mixed bowel habits, and IBS unclassified. Classification of IBS is based on the Rome criteria, which differentiates subtypes. Symptoms may include abdominal pain, bloating, constipation, diarrhea, sensation of incomplete evacuation, and straining. IBS may also present with abdominal pain and altered bowel movements, but without evidence of another medical condition. ![]() The primary goal is to achieve a brisk and deep remission, which will substantially decrease the risk for disease relapse and long-term complications. There are several classes of biologics, immunomodulatory, and anti-inflammatory medications which are used as maintenance therapy. Once a diagnosis is confirmed, treatment is dependent on the disease phenotype, severity, and several other factors. ![]() Definitive diagnosis requires endoscopic evaluation and possibly abdominal imaging. Initial testing should include ruling out infection and assessing inflammatory markers (serum and stool), screening for anemia, hypoalbuminemia, electrolytes, and liver enzymes. Overlapping and distinct symptoms of inflammatory bowel disease and irritable bowel syndrome. Physical exam may reveal clues like oral ulceration, perianal fistulae, and skin tags, in addition to the extra-intestinal manifestations.įigure 1. Unexplained fevers, chronic rashes (erythema nodosum and pyoderma gangranosum), arthritis/enthesitis, and ocular symptoms may also be present. Vomiting in this context could reflect bowel stricturing. While abdominal pain, loose stools, and loss of appetite are non-specific, fecal urgency and hematochezia may indicate colitis, whereas growth delay may indicate small bowel disease. The presentation of these conditions includes a broad range of extra-intestinal and constitutional symptoms. The incidence of IBD continues to increase in children, and particularly so in young, school-aged children. The proposed pathophysiology is complex, involving interplay between gut flora, environmental factors, an altered mucosal immune system, and genetic factors. IBD, which includes Crohn's disease and ulcerative colitis, are chronic inflammatory conditions of the digestive track. Stool studies for common enteric pathogens were negative.ĭiscussion: While the presentation of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) may be very similar, there are clinical clues and diagnostic tools that can help make the crucial distinction between these two conditions. ![]() Growth parameters show no weight gain from her well child exam 2 years prior, but an appropriate increase in height. Her perianal and rectal examination is unremarkable. She does not have any tenderness on exam or organomegaly. She lives with her mother and spends weekends with her father, as they separated 8 months ago. Although her sleep has been affected periodically by pain and bowel movements, she continues to do very well academically and has not missed class due to symptoms. She has been taking lactobacillus every day for the past month without any change in symptoms. The symptoms seemed to coincide with the start of the current school year, her freshman year of high school. Her appetite is inconsistent and she has intermittent nausea. Her pain does not typically improve after defecation. She also has between 2 to 4 loose and non-bloody stools daily, which is a change from her baseline stool characteristics. The pain is crampy in nature and does not radiate. Contributed by: Jennifer Webster, DO and Art Kastl, MD Case: KD is a 14-year-old female with no prior medical history who presents to your outpatient office with a 6-month history of generalized abdominal pain that has been increasing in frequency over time.
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