MONTREAL — The presence of symptoms outside the gastrointestinal tract can help distinguish irritable bowel syndrome from inflammatory bowel disease, Noel B. Hershfield, M.D., said at the 13th World Congress of Gastroenterology.
Patients with irritable bowel syndrome (IBS) are more likely than patients with inflammatory bowel disease (IBD) to present with fatigue, depression/anxiety, and headache, as well as sleep loss for reasons not related to intestinal discomfort, Dr. Hershfield reported.
He reached these conclusions based on his survey of about 400 patients who came to his outpatient clinic. All of the patients were younger than 50 years old.
Of the 200 patients with IBS, almost three-quarters had chronic fatigue syndrome, compared with one-quarter of the similar number of patients with IBD.
Nearly half of the IBS patients reported headaches, compared with less than a quarter of the patients with IBD.
More than 40% of IBS patients had depression or anxiety; that figure was less than 10% for the IBD group, said Dr. Hershfield, a gastroenterologist at the University of Calgary (Alta.).
Among the IBS patents, 156 reported sleep disturbance not due to GI symptoms, compared with only 12 of the IBD patients. Conversely, only 2 IBS patients reported sleep disturbance due to GI pain, compared with 179 of the IBD patients (Can. J. Gastroenterol. 2005;19:231–4).
“The object of this paper was to get physicians to take a better history, so they wouldn't have to do so many tests to prove IBS,” he said. “If you spend some time with them, you don't have to do very many tests to know that they have irritable bowel—you don't have to colonoscope them, or x-ray them, or all that stuff. It costs a fortune to do that.”
Night sweats, sleep disturbance due to diarrhea and abdominal pain, and weight loss are symptoms of organic bowel disease. “People with IBD often have tremendous weight loss. They show up with problems related to poor nutrition, they can't eat, they don't absorb food properly, so they lose weight and all the things that go with that,” Dr. Hershfield said.