IBS And Other Causes Of Diarrhea

Dr. AkermanDr. Stuart Akerman is a Board Certified Gastroenterologist and happily married father of 3 beautiful girls. When he is not actively working alongside his patients he can be found playing a game of pickup basketball, volunteering in the community, or sharpening his skills on Just Dance with his daughters. You can learn more information about Dr. Akerman at his website www.stuartakermanmd.com

IBS and other causes of diarrhea

Many Americans today carry a diagnosis of IBS – Irritable Bowel Syndrome. Some estimates are as high as 45 million patients at any given time. There are many therapies offered to target diarrhea, belly pain, and emotional distress.  These include medicines, herbal supplements, and diets, as well as yoga, behavioral therapies, and lifestyle changes. Yet despite all these great options only a smaller percentage of patients than we like to find that their symptoms are well controlled.

Why is this?

To start there is no specific test to diagnose IBS; rather there are accepted signs and symptoms, called the Rome Criteria (currently in version 4). If you meet enough of them you can carry a diagnosis of IBS. Unfortunately, this method is a bit flawed. It means that many people with similar symptoms are being grouped together, but they may have different problems. It’s hard to imagine that there would be a single treatment that’s going to work and get the same results for millions of people if you are trying to treat people with a bunch of different underlying problems.  

So if I meet these “Rome Criteria” that mean I have IBS?

Not necessarily. One of the main issues at hand is that many of these symptoms are not specific and may overlap with other diagnoses. You may have even seen marketing recently for tests that will “diagnose” IBS. In fact, these tests (as of the time of writing this article) just suggest that you may or may not be more likely to have IBS.

How is this typically evaluated? When would I be told I have IBS?

When you see a GI doctor for diarrhea that’s been going on for weeks or months (or years!) you will often start with some level of testing which will often include stool samples and a colonoscopy or an endoscopy. A colonoscopy is a test where while you are sleeping, a camera on a thin tube is used to look at the colon. An endoscopy is a similar test except the tube is used to look at the stomach and beginning of the small intestine. What is actually being tested in the stool can vary, and what and where you get biopsies depends on your specific symptoms. For many years this is all we had to use for testing.

Often at this point, if everything is negative and you do not have any “alarm” symptoms, you are given a diagnosis of IBS. I have seen many patients in my career for 1st, 2nd, or even 3rd opinions for IBS. Many come to get tested because they are not doing very well and their symptoms are not controlled. Some of them benefit from eval with newer, expanded stool tests. Some benefit from getting an Endoscopic Ultrasound  – a test that uses the camera from an endoscopy and adds a small ultrasound to the tip. This allows the doctor to get a good look at your pancreas, liver, and gallbladder.


What are some of the other issues that can be found to explain my diarrhea instead of IBS? What are some alternative diagnoses?

  • Bile Salt Diarrhea – where you lose salt and bile into the colon
  • Chronic Pancreatitis – scarring of the pancreas, which is an organ needed for digestion
  • IBD (not IBS) – Inflammatory Bowel Disease – This is inflammation of the small or large intestine. You may be familiar with Crohn’s Disease or Ulcerative Colitis; they are the 2 types of IBD
  • Microscopic Colitis – chronic inflammation or thickening of the colon just underneath the surface
  • Celiac Disease
  • EPI – Exocrine Pancreatic Insufficiency, which we will explain a little deeper

EPI – I’ve been hearing about that on TV and the internet

Yes “EPI” has become somewhat of a buzzword in the media. You use your pancreas to produce insulin as well as other enzymes that you need to digest food well. The most common reason for low levels of an enzyme is chronic pancreatitis, where the pancreas becomes scarred. However many patients with an otherwise normal pancreas may suffer from it as well. Symptoms can be remarkably similar to IBS – bloating, pain, nausea, diarrhea – so you can see how it can be easily missed if you aren’t looking for it. If you have EPI wouldn’t you want to find out so you can get treatment targeted for that rather than treatment for IBS?

Do you think I really have IBS? Should I get re-evaluated?

Well, if you are doing well without getting symptoms on a regular basis it sounds like you are doing just fine. If it ain’t broke, don’t fix it! But if you still have a significant amount of symptoms, and especially if you have alarm symptoms such as weight loss or bleeding, then you should call and schedule a visit. Especially when it comes to looking for more mild changes of the pancreas, Endoscopic Ultrasound can be more sensitive than CT scans or MRI. You can even think of it as watching a basketball or football game on an old SDTV or on an HDTV. Both TVs will let you watch the game, but HD lets you see it better, and enhances the overall experience.

This is all great, but I’ve been tested by a few different people and they all say I have IBS – what should I do?

Don’t let it get you down! IBS can be a tough nut to crack for anybody. The most important fact about IBS to understand is that it is different for everyone. Once you understand that, you can see why there is no magic bullet that can fix it every time for every person. Working closely with your provider is key, addressing both your physical and emotional symptoms. There are many great symptomatic treatment options out there, and sometimes it may just take a bit longer to find the right combination that works for you. 

IBS And Other Causes Of Diarrhea