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What are the tests to be done to diagnose Irritable Bowel Syndrome?

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Internal Medicine Specialist
Practicing since : 1980
Answered : 1357 Questions
Hi Doctor, My daughter is suffering from all the symptoms of Irritable Bowel Syndrome i.e going to the toilet four to five times in the morning, sometimes diarrhea in the afternoon and pain. She has taken Medrol, Librax and Azoran for nearly five months with some improvement. But as soon as she stopped the medicines she gets all the symptoms again. She consulted another Doctor who prescribed her Debridat and Asacol. Treatment with Debridat has been completed and now she is taking Asacol , one tablet daily. A slight improvement was noted in the afternoon episode but in the morning it is still the same. She missed her Asacol tablet on three days and since yesterday she is suffering from abdominal pain and she is not at ease. I want to know whether she is taking the right medicines for what she is suffering because she has not done any test apart from a Colonoscopy where it was found that she has mild inflammation only. I would also like to know what other test she has to do to diagnose her disease.
Posted Wed, 19 Mar 2014 in IBS(Irritable Bowel Syndrome)
Answered by Dr. Rakesh Karanwal 56 minutes later
Brief Answer: The treatment given is NOT for IBS Detailed Answer: Hi there, Thanks for your query. Firstly, let us first get the diagnosis straight, and also, other problems present. 1. Did the doctor give the diagnosis as Irritable Bowel Syndrome (IBS), or it is your presumption. This is important because the treatment being given to your daughter is for ulcerative/non-specific colitis or Crohn's disease. The treatment for IBS is DIFFERENT. 2. Does your daughter pass mucus or blood in the stools? are the stools loose and does she have any persistent abdominal discomfort/vague generalized pain?? Since how long has she been having frequent stools??any redness of eye in the past? any joint pains? is she passing through constant mental stress/anxiety? any weight loss in the recent past?? 3. What was the stool examination report, if done? I will not be able to comment on whether she is on correct treatment or not, till you provide me with further details as requested. Incidentally, I feel that you should know about IBS, which is characterized by presence of symptoms for at least six months; recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months associated with improvement with defecation. In my vast clinical experience, I have had a success rate of almost 100% in cases of IBS, with an course of Metronidazole x 7-10days + a single tablet course of deworming agent, such as, (Albendazole 400mg); FOLLOWED by, a long-term course of a combination of an anti-depressant + anti-anxiety drug + Probiotics (Lactobacilli). Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Nevertheless, I would be looking forward to the requested information. Fond regards and have a nice day, Col (Dr.) Rakesh Karanwal
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Follow-up: What are the tests to be done to diagnose Irritable Bowel Syndrome? 20 hours later
Hi Doctor, Thanks for your reply. Your questions are answered below: 1. 1st Doctor ( MB FRCP) who treated my daughter did not mention IBS or Crohn's Disease. But in Biopsy report recommended by him the conclusion is " Non- Specific Colitis" and medicines prescribed by Doctor were Medrol, Azoran, Librax . Treatment was for 5 months. A relapse of the symptom were noted when medicines were stopped. 2nd Doctor ( Consultant Surgeon/ Uro Surgeon) did not recommend any test but prescribed Flagentyl, Debridat and Asacol based of tests carried out by 1st Doctor. He presumed that my daughter may be suffering from IBS or Crohn's disease. She is having recurrent abdominal pain or discomfort since one and a half year .Abdominal pain 3-4 times per week and the wish to defecate nearly every day 4-5 times in the morning and 2-3 times in the afternoon. 2.Q: Mucus or Blood in Stool. A: Mucus : No Blood : Only on two occasions before XXXXXXX 2013 ( May be due to constipation ) Q: Persistent Abdominal Pain/ Vague Generalised Pain. A: It is Gas Pain which may last the whole day and may be associated with a loose stool. She feels certain discomfort as if she wants to defecate and feels quite relieve after defecation. Q: How Long frequent stools: A: Since one and a half year Q: Redness of Eyes A : No Q:Any Joints Pain A: Joints pains since she took Medrol otherwise she always feels tired. Q: Constant Mental Stress/ Anxiety. A: Yes, a lot of mental stress Q: Any weight Loss. A : No, she has rather gained weight. She eats a lot of junk foods as she is always hungry. Q : Stool examination: A: Report dated 13/9/13: Semi-solid, Brownish, blood absent, WBC 0-3, RBC 0-2, Macrophages 1-2, Mucous + Hope that the above information will help you make a diagnosis of her disease ( I.e whether it is IBS or Colitis and whether it is treatable). Grateful to have your advice at the earliest. I have her Biopsy Report and stool examination report with me but I am not given the option to send them with " Follow-up Question" Thanks XXXX
Answered by Dr. Rakesh Karanwal 1 hour later
Brief Answer: The presentation is highly suggestive of IBS Detailed Answer: Hi there, The additional details have given me invaluable information. The duration of symptoms and presentation, are suggestive of a typical IBS, except that the colonoscopic biopsy findings of "non-specific colitis" muddles the matter. So, the possibilities are that either, * long-standing IBS has lead to mild, non-specific inflammation of the colon; or, * she has concurrent 'non-specific colitis' along with IBS. I assume that she is presently only on one tablet of Asacol per day, as mentioned by you under the heading "current medications". If I were her treating specialist, I would have put her initially on 4 weeks course of the following drugs:- 1. Anti-depressant, such as sertraline or Escitalopram 2. An anti-anxiety drug, such as, clonazepam or alprazolam in gradually increasing doses 3. 10-14 days' course of Rifaximine 4. A Probiotic, such as, Lactobacilli 5. Pancreatic digestive enzymes 6. Continue with Asacol once a day in the same dose. After 4 weeks, I would have assessed the response, based on which, further treatment would have been continued/modified. You may therefore consult her treating doctor and apprise him of my opinion. I am sure that he will agree with me and prescribe the advised drugs in appropriate doses. Lastly, you are most welcome to revert back to me with the response, after 4 weeks, if you wish. Fond regards, Dr. Rakesh Karanwal
Above answer was peer-reviewed by
Follow-up: What are the tests to be done to diagnose Irritable Bowel Syndrome? 27 minutes later
Thanks a lot Doctor for your valuable advice. Do you think a CT Scan of her belly is important as the second Doctor has recommended her for a CT scan which has not yet been done Or she may proceed directly with the medicines advised by you without getting the scan done. You also mentioned in your previous reply that you have had a success rate of 100% in cases of IBS. Due to the seriousness of the case of my daughter do you think she can be cured at 100% and if ,in the affirmative,how long does it take for complete cure. Best regards XXXX
Answered by Dr. Rakesh Karanwal 2 hours later
Brief Answer: IBS is incurable Detailed Answer: Well, I don't see the necessity of a CT scan, since colonoscopy (which has already been done) is more valuable and informative. May I clarify that IBS is NOT curable and that I had mentioned 100% success rate of achieving control of the symptoms, while on medicines (and not curative rate). However, since mental/emotional stress/depression plays a significant role in the aggravation of symptoms, cure of the psychological problems will automatically regulate the bowel problems. Have a nice day
Above answer was peer-reviewed by
Follow-up: What are the tests to be done to diagnose Irritable Bowel Syndrome? 19 hours later
Good Morning Doctor, Thanks again for your reply. I will proceed as per your advice and will revert back to you after treatment with medicines suggested by you. Kind regards XXXX
Answered by Dr. Rakesh Karanwal 5 hours later
Brief Answer: Full effect of drugs will be evident after 4 weeks Detailed Answer: The full effect of the medicines would be evident only after 4 weeks. You are therefore requested to kindly update me with the extent of improvement after four weeks only. Wish a speedy recovery to your daughter. Fond regards
Above answer was peer-reviewed by
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