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The Gut Project
 

IBS Symptoms - Discussion

The value of specific gastrointestinal symptoms in discriminating irritable bowel syndrome (IBS) from organic disease has been previously documented. In contrast, there have been few attempts to identify symptoms that discriminate irritable bowel syndrome from food allergy, despite similarities in their respective symptom complexes. A study from Italy investigated the value of symptoms in discriminating irritable bowel syndrome from organic disease and food allergy.

In this study, 288 subjects were recruited from consecutive patients presenting to the Internal Medicine, Gastroenterology and Allergy Units in Chieti. Patients completed the validated Bowel Disease Questionnaire (BDQ) prior to an independent diagnostic evaluation, which included endoscopy when appropriate. Food allergy was diagnosed using a 2-week elimination diet, followed by a placebo-controlled food challenge test, a skin prick test and serum RAST for specific IgE for suspected foods or additives. The results of the BDQ were not considered in formulating a diagnosis. In total, 99 patients were diagnosed with IBS, 79 patients were diagnosed with organic disease (e.g. Crohn’s disease, ulcerative colitis) and 22 patients were diagnosed with food allergy. A further 88 patients with extraintestinal allergies were included as a control group.

Based on logistic regression analysis, 6 symptom items discriminated IBS from organic disease, 5 IBS from control subjects, and 4 symptom items discriminated IBS from food allergy patients.

A diagnosis of IBS compared to organic disease was positively associated with:

  • straining on defecation
  • diarrhea, and
  • abdominal bloating

And was negatively associated with:

  • pain in the upper abdomen
  • reflux, and
  • appetite loss

A diagnosis of IBS compared to extraintestinal allergy was positively associated with:

  • pain relieved by bowel movement,
  • pain in the lower abdomen,
  • pain in both the upper and lower abdomen,
  • frequent pain, and
  • abdominal bloating

In comparison between IBS and food allergy patients, a diagnosis of IBS was positively associated with:

  • pain in the lower abdomen,
  • pain relieved by bowel movements,
  • frequent pain, and
  • abdominal bloating.

Conclusion

Symptoms appear to be useful for discriminating IBS from organic gastrointestinal disease and food allergy.

Staff Writers
First published in The Inside Tract® Newsletter Issue 134 November/December 2002

Reference:

Eur J Gastroenterol Hepatol 2000 Sep;12(9):981-8