Inflammatory bowel disease, irritable bowel syndrome, clinical features and differentials - Part 2
Inflammatory bowel disease video series part 3 and second part of clinical features video in this series - A breakdown of clinical features that can aid in differentiating these conditions:
Inflammatory Bowel Disease (IBD):
Symptoms: Chronic diarrhea (often with blood), abdominal pain, weight loss, fatigue, fever, and sometimes extraintestinal manifestations like joint pain or skin lesions.
Tests: Endoscopy, colonoscopy, biopsies, blood tests (CRP, ESR), stool tests, imaging (CT or MRI enterography).
Ischemic Colitis:
Symptoms: Sudden onset abdominal pain, typically in older adults, often after a low-flow state (e.g., surgery, low blood pressure). Bloody diarrhea may occur but is less common than in IBD.
Tests: Colonoscopy, CT angiography, blood tests (lactate, leukocytosis).
Irritable Bowel Syndrome (IBS):
Symptoms: Recurrent abdominal pain associated with altered bowel habits (constipation, diarrhea, or both) without evidence of inflammatory, anatomical, metabolic, or neoplastic causes.
Tests: Typically a diagnosis of exclusion. Criteria include Rome IV criteria, ruling out other conditions.
Behcet's Disease:
Symptoms: Recurrent oral and genital ulcers, skin lesions, uveitis, arthritis, and in some cases gastrointestinal involvement with symptoms resembling IBD.
Tests: Diagnosis is clinical based on specific criteria including oral/genital ulcers plus additional features. May involve skin biopsy, and HLA-B51 testing.
Infective Colitis:
Symptoms: Diarrhea (often bloody), abdominal pain, fever, and systemic symptoms. History of recent travel, antibiotic use, or exposure to pathogens.
Tests: Stool cultures, PCR for specific pathogens, blood tests, colonoscopy.
Colorectal Cancer:
Symptoms: Change in bowel habits, blood in the stool, abdominal discomfort, unintended weight loss, fatigue.
Tests: Colonoscopy with biopsy, fecal occult blood tests, imaging (CT scan, MRI), blood tests (CEA).
Distinguishing these conditions often requires a combination of clinical history, physical examination, laboratory investigations, and imaging studies. A thorough evaluation by a healthcare provider is crucial for accurate diagnosis and appropriate management.