Irritable Bowel Syndrome - Diagnosis - NICE Guidelines

A 35-year-old female presents with abdominal pain associated with bloating for the past 6 months, Which one of the following symptoms is least associated with a diagnosis of irritable bowel syndrome?
A. Feeling of incomplete stool evacuation
B. Weight loss
C. Back pain
D. Lethargy
E. Nausea

Answer:
B. Weight loss

Discussion: Weight loss is not a feature of IBS and underlying malignancy or inflammatory bowel disease needs to be excluded

Irritable bowel syndrome: diagnosis NICE published clinical guidelines on the diagnosis and management of irritable bowel syndrome (IBS) in 2008
The diagnosis of IBS should be considered if the patient has had the following for at least 6 months:  abdominal pain, and/or
 bloating, and/or
 change in bowel habit

A positive diagnosis of IBS should be made if the patient has abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:  altered stool passage (straining, urgency, incomplete evacuation)
 abdominal bloating (more common in women than men), distension, tension or hardness
 symptoms made worse by eating
 passage of mucus

Features such as lethargy, nausea, backache and bladder symptoms may also support the diagnosis

Red flag features should be enquired about:
 rectal bleeding
 unexplained/unintentional weight loss
 family history of bowel or ovarian cancer
 onset after 60 years of age

Suggested primary care investigations are:
 full blood count
 ESR/CRP  coeliac disease screen (tissue transglutaminase antibodies)