How has the thinking regarding the diagnosis of IBS changed in the past 20 years?

Joseph Sweeting MD

Thinking about how to make the diagnosis of IBS has changed a great deal. Twenty years ago, this was largely a disease of exclusion. That is, patients came to doctors with a variety of complaints; they were often put through multiple tests to rule out, or exclude, all sorts of things. And if nothing was found, the diagnosis of IBS was applied to the patient. It was often very disconcerting to the patients to be approached that way.

Now, we now have fairly strict criteria for making the diagnosis. There are what is known as the Rome II criteria, which are being used more and more as a framework for making the diagnosis. There are specific things that doctors should look for and ask that are listed on the Rome criteria. Using that, plus other data that can be acquired from the patient directly about how they respond to different medications and so forth, can move the doctor towards a more specific diagnosis of irritable bowel fairly quickly.

Now the age of the patient makes a great deal of difference here. Diagnosis of a young patient with symptoms of an irritable bowel syndrome can be made with minimal investigation. With an older patient and presentation of symptoms that can occur in older age, a more elaborate workup is required to make sure that other problems are not being overlooked. But our thinking about this has changed greatly. We now try to make a specific diagnosis rather than simply ruling out everything else.