IBS and Diagnostic Procedures

By Charles Gerson, M.D.

At the MBDC, we gave become concerned about the number of unnecessary procedures performed on patients with IBS. Most patients seen at our Center have been under the care of other gastroenterologists. One of the questions we ask them to describe is the diagnostic procedures they have had. This includes colonoscopy, gastroscopy, capsule endoscopy of the small intestine and CT scan of the abdomen.

Almost all patients have had at least one colonoscopy, sometimes more than one and many have had the other procedures listed. . What are necessary procedures? There has been expertopinion published about this question. It is generally accepted that if an IBS patient has one of the following “red flags”, evaluation is warranted.

Red flags
  • Rectal bleeding (not obvious hemorrhoidal blood on the toilet tissue)
  • Awakening in the night by GI symptoms
  • Unintended weight loss
  • Colon cancer family history
  • Symptoms began after age 50
  • Recent antibiotic use for GI symptoms.
We would add one more indication, diarrhea predominant IBS (as opposed to constipation predominant IBS).

However, it should be noted that even if a patient with IBS has one of the “red flags”, the diagnostic work-up is usually negative.

In the absence of “red flags”, a diagnosis of IBS should be made with confidence by a physician on the basis of the patient’s history alone, with no dagnostic tests necessary.

FINALLY, gastroscopy (examination of the esophagus, stomach and upper small intestine) has no place in evaluation of IBS unless the patient has significant upper GI symptoms such as repeated heartburn or acid indigestion.