FREQUENCY OF ORGANIC PATHOLOGIES IN PATIENTS WITH IRRITABLE BOWEL SYNDROME

Abstract

Objective: To evaluate Irritable bowel syndrome (IBS) labeled patients, meeting symptom based criteria of IBS, for organic pathologies.

Material and Methods: This descriptive study was carried out in Gastroenterology Department, Hayat Abad Medial Complex, Peshawar, during the period from March 2003 to March 2005.

A total of 85 consecutive patients were included in the study, who were labeled as IBS by the General Practioners. All of them were meeting symptom based criteria (ROME II) for IBS. Informed consent was taken. Patients with alarm signs including dysphagia, rectal bleeding, anemia, weight loss, family history of colon cancer, were excluded from the study. Detailed history and physical examination was done. Laboratory evaluation ,which included complete blood count, erythrocyte sedimentation rate(ESR), blood urea, serum creatinine, serum electrolytes, liver function tests, thyroid function tests, and stool xamination for ova, parasites and culture when indicated, was done. Patients underwent Upper G I Endoscopy, Ultrasound of the abdomen, Flexible sigmoidosopy and/or Full length colonoscopy as indicated. Other investigations like small gut biopsy, celiac serology and biopsy from the large gut were done as needed.

Results: Out of the 85 patients, 68(80%) were males and 17(20%) were females. Abdominal pain was the most common, present in 65(76 %) patients out of 85 patients.All these patients had mixed type of IBS symptoms, having both diarrhea and Constipation. Laboratory investigations were normal in almost all patients except in 5(5.8%) patients, who were having evidence of hypochromic microcytic anemia. All these

five patients were having mixed pattern IBS. Three (3.5%) were males and their celiac serology and small gut biopsy showed evidence of celiac sprue. Ten (12%) of patients were having cysts of Amoeba in their stools routine examination but there were no trophozytes found. Another 15(17%) patients were having non significant hemorrhoids on lower GI endoscopy. 17(20%) of patients were having antral gastritis on EGD, but the biopsy showed non specific gastritis.

Conclusion: Irritable bowel syndrome can be diagnosed clinically, using ROME II criteria and a few inexpensive and non invasive tests. In patients with IBS-D and IBS-M routine serological screening for celiac sprue may be a cost effective strategy.