MEDizzy - A 32-year-old white woman complains of abdominal pain off

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Gastroenterology 2

A 32-year-old white woman complains of abdominal pain off and on since the age of 17. She notices abdominal bloating relieved by defecation as well as alternating diarrhea and constipation. She has no weight loss, GI bleeding, or nocturnal diarrhea. On examination, she has slight LLQ tenderness and gaseous abdominal distension. Laboratory studies, including CBC, are normal. Which of the following is the most appropriate initial approach?

ExplanationThis patient meets the Rome II criteria for irritable bowel syndrome. The major criterion is abdominal pain relieved with defecation and associated with change in stool frequency or consistency. In addition, these patients often complain of difficult stool passage, a feeling of incomplete evacuation, and mucus in the stool. In this young patient with long-standing symptoms and no evidence of organic dis- ease on physical and laboratory studies, further evaluation (ie, colonoscopy or small bowel studies for sprue) is unnecessary. Irritable bowel syndrome is a motility disorder associated with altered sensitivity to abdominal pain and distension. It is the commonest cause of chronic GI symptoms and is three times more common in women than in men. Associated lactose intolerance may cause similar symptoms and should be considered in all cases. Patients older than 40 years with new symptoms, weight loss, or positive family his- tory of colon cancer should have further workup, usually with colonoscopy.