Irritable Bowel Syndrome: Or something else? Differential Diagnosis

The irritable bowel syndrome leading symptoms are highlighted as shown below:

  • 1Diarrhea (diarrhea).
  • 2Pain
  • 3Obstipation (constipation)
  • 4Flatulence, distension (feeling of overstretching in the intestine).

DiseasesInfectious and parasitic diseases (A00-B99).

  • Diarrhea1 (wg infectious enterocolitis).

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • C1 esterase inhibitor deficiency2 – deficiency of this protein is called hereditary angioedema (or hereditary angioneurotic edema).
  • FODMAP intolerance1+4: Abbreviation for “fermentable oligo-, di- and monosaccharides and polyols” (= sugar alcohols, such as maltitol, sorbitol etc. )); FODMAP‘s are e.g. wheat, rye, garlic, onion, milk, honey, apple, pear, mushrooms, salicylate; fermentation produces gases and the binding of water can have a laxative effect. Note: According to a study, a slower bread preparation in traditional bakery ensures that the components in the bread that cause discomfort are already degraded by the time it is baked.
  • Fructose intolerance1 + 4 (fructose intolerance).
  • Bile acid malabsorption (chologenic diarrhea: diarrheal disease caused by increased bile from the small intestine to the large intestine).
  • Gluten sensitivity (non-celiac gluten allergy-nonwheat sensitivity (NZNWWS); English Non-coeliac gluten sensitivity, NCGS)1 + 4 – non-allergic and non-autoimmune condition in which consumption of gluten may result in celiac-like symptoms;
    • Time to onset of symptoms: variable, hours to days.
    • Clinical picture: abdominal pain (abdominal pain), meteorism (flatulence), diarrhea (diarrhea)/nausea(nausea), possibly also headache, foggy mind (foggy senses), fatigue, myalgia (muscle pain), exanthema (skin rashes) and neurological symptomsDiagnosis; at least six weeks of gluten-containing normal diet, then another six weeks of gluten-free diet;
      • No improvement in symptoms: a gluten sensitivity can be excluded.
      • Regression of symptoms: a double-blind placebo-controlled provocation test is required to confirm the diagnosis:
        • Gluten-free diet and 8 mg of gluten in a capsule or placebo daily for one week; after a one-week washout period, placebo or gluten again for another week in a crossover design (same subjects given the test drug and the control drug sequentially).Positive test: reduction of symptoms by at least 30 percent under placebo– compared with gluten provocation.
    • Laboratory diagnostics: determination of gliadin antibodies; skin test: no.
    • Occurrence; one in 5 irritable bowel patients).
  • Histamine intolerance1 (histamine intolerance) – typical symptoms include flushing, nausea, diarrhea, migraine headache, feeling hot and shortness of breath.Note: Flushing is a seizure-like violent flushing of the skin of the face and neck region (possibly also the upper body).
  • Hyperthyroidism1 (hyperthyroidism).
  • Hypoparathyroidism1 + 3 (parathyroid hypofunction).
  • Hypothyroidism3 (hypothyroidism)
  • Lactose intolerance1 + 4 (lactose intolerance).
  • Non-celiac wheat sensitivity
  • Porphyria attack2, acute – Porphyria or acute intermittent porphyria (AIP); genetic disease with autosomal dominant inheritance; patients with this disease have a 50 percent reduction in the activity of the enzyme porphobilinogen deaminase (PBG-D), which is sufficient for porphyrin synthesis. Triggers of a porphyria attack, which can last a few days but also months, are infections, drugs or alcohol. The clinical picture of these attacks presents as acute abdomen or neurological deficits, which can take a lethal course.The leading symptoms of acute porphyria are intermittent neurological and psychiatric disturbances. Autonomic neuropathy is often in the foreground, causing abdominal colic (acute abdomen), nausea (nausea), vomiting or constipation (constipation), as well as tachycardia (heartbeats > 100 beats/min) and labile hypertension (high blood pressure).
  • Sorbitol tolerance1 (sorbitol intolerance) – disturbance of the utilization of sorbitol in the small intestine.
  • Wheat allergy – time to onset of symptoms: hours to days; determination of wheat IgE; skin test.
  • Wheat sensitivity (synonym: nonceliac gluten sensitivity, NCGS) – time to onset of symptoms: variable, hours to days; symptoms may be intestinal (“affecting the intestine”) and extraintestinal (“outside the intestine”); gliadin antibodies: negative; IgE antibodies positive; skin test: no. Cause of wheat sensitivity are amylase trypsin inhibitors (ATIs), which are found in wheat, barley and rye; a gluten-free diet leads at the same time to an avoidance of ATIs and thus in about 90% of cases to a disappearance of symptoms.rnährung leads at the same time to an avoidance of ATIs and thus in about 90% of cases to a disappearance of symptoms.

Liver, gallbladder and bile ducts – pancreas (pancreas) (K70-K77; K80-K87).

  • Cholelithiasis2 (gallstones).
  • Chologenic diarrhea1 – if bile acids enter the colon (large intestine), bile acid-induced diarrhea results from the osmotic effect of the bile acids
  • Biliary diseases1, unspecified
  • Pancreatitis1 (inflammation of the pancreas), chronic

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Bacterial overgrowth1 + 4 (Small Intestinal Bacterial Overgrowth, SIBO) [dysbiosis].
  • Bacterial overgrowth of the small intestine1 + 4 (dysbiosis).
  • Chronic appendicitis2 (appendicitis; Attention! > 25% location variants of the appendix / appendix).
  • Ulcerative colitis1 – chronic inflammatory disease of the mucosa of the colon (large intestine) or rectum (rectum).
  • Intestinal infections1, unspecified
  • Diverticular disease3, chronic
  • Diverticulitis2
  • Small intestinal stenosis2
  • Gastroparesis – paralysis of the stomach muscles.
  • Intestinal ischemia – circulatory disorders of the intestine.
  • Intestinal obstruction – narrowing of the intestine due to a tumor, inflammation or foreign body.
  • Colitis1 (inflammation of the intestine), infectious.
  • Colonic diverticulosis – protrusions of the mucosa in the colon.
  • Mesenteric ischemia2 – irreversible disturbance of blood flow to intestinal organs.
  • Microscopic colitis or microscopic colitis1 (synonyms: collagenous colitis; collagen colitis, collagen colitis) – chronic, somewhat atypical course of colonic mucosal inflammation, the cause of which is unclear and which is clinically accompanied by violent watery diarrhea (diarrhea)/4-5 times a day, including at night; some patients suffer from abdominal pain (abdominal pain) in addition; 75-80% are women/females > 50 years of age; correct diagnosis is only possible with colonoscopy (colonoscopy) and step biopsies (taking tissue samples in the individual sections of the colon), i.e. i.e., by a histological (fine tissue) examination to establish; as a differential diagnosis with long-standing symptom duration consider.
  • Motility disorders (disorders of intestinal movement), in particular also pseudoobstruction (apparent mechanical obstruction, without organic, systemic or metabolic disorders exist) and anorectal dysfunction (“affecting the anus and rectum / rectum”).
  • Crohn’s disease1 + 2 – chronic inflammatory bowel disease; it usually progresses in relapses and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa, that is, several intestinal segments may be affected, which are separated by healthy sections; consider as a differential diagnosis in the case of long-standing symptom duration
  • Stenoses2 (narrowings; also radiogenic/due to radiotherapy, brides/obstructions of abdominal viscera and peritoneum).
  • Fecal incontinence1 – inability to retain the intestinal contents as well as intestinal gases arbitrarily in the rectum.
  • Ulcers – ulcers, especially in the stomach and duodenum.
  • Celiac disease1 (gluten-induced enteropathy) – chronic disease of the mucosa of the small intestine (small intestinal mucosa) due to hypersensitivity to the cereal protein gluten (even without diarrhea (diarrhea); consider as a differential diagnosis if symptoms persist for many years).

Neoplasms – tumor diseases (C00-D48).

  • Gastrointestinal tumors2
  • Hormone-responsive neuroendocrine tumors1 + 2
  • Colon carcinoma1 + 2 + 3 (colorectal cancer) (paradoxical diarrhea; alternating with constipation).
  • Gastric carcinoma2
  • Ovarian tumors2 (ovarian tumors) – ovarian cancer (ovarian cancer).
  • Pancreatic carcinoma2 (pancreatic cancer).

Psyche – nervous system (F00-F99; G00-G99)

  • Autonomic neuropathy1 (diabetes mellitus).

Pregnancy, childbirth, and puerperium (O00-O99)

  • Extrauterine pregnancy2 (gravidity (pregnancy) in which nidation (implantation) of the blastocyte (embryo in the early stage of development; arises from the morula/mulberry stage on approximately day 4 after fertilization) occurs outside the uterus (womb)).

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Adnexitides – inflammation of the so-called. Adnexa (= combination of inflammation of the fallopian tubes and the ovary).
  • Endometriosis2 – Occurrence of endometrium (endometrium) outside the uterus, for example in or on the ovaries (ovaries), tubes (fallopian tubes), urinary bladder or intestine. It is a chronic estrogen-dependent (female sex hormone) disease.
  • Ovarian cyst (ovarian cyst).
  • Cystitis2 (inflammation of the bladder)

Further

  • Food allergy1
  • Postoperative dysfunction2 + 4 (e.g., brides).

Medications

Environmental stress – intoxications (poisonings).

  • Lead3