From the Guidelines
A 3-month history of symptoms is suggestive of a chronic condition, and based on the Rome II Diagnostic Criteria, Irritable Bowel Syndrome (IBS) should be considered as a potential diagnosis if the symptoms meet the specified criteria. When evaluating a patient with a 3-month history of symptoms, it is essential to consider the duration and characteristics of the symptoms, as well as any potential underlying causes. According to the American Gastroenterological Association medical position statement on IBS 1, the diagnosis of IBS is based on the presence of abdominal discomfort or pain that has at least two of the following features: relieved with defecation, onset associated with a change in frequency of stool, and/or onset associated with a change in form of stool.
Key Considerations for Diagnosis
- The symptoms should have been present for at least 12 weeks, which need not be consecutive, in the preceding 12 months.
- The diagnosis of IBS presumes the absence of a structural or biochemical explanation for the symptoms.
- A complete physical examination, sigmoidoscopy, and additional testing when indicated should be performed to rule out other potential causes of the symptoms.
Evaluation and Testing
- A stool Hemoccult and complete blood count are recommended for screening purposes.
- A sedimentation rate, serum chemistries, and albumin may be ordered based on symptom pattern, geographic area, and relevant clinical features.
- A colonoscopy is recommended for patients over age 50 years, but in younger patients, the decision to perform a colonoscopy or sigmoidoscopy is determined by clinical features suggestive of disease.
Treatment and Management
- Treatment can be started based on the symptom subtype, and the patient's condition should be reevaluated in 3-6 weeks.
- If treatment is unsuccessful, or if further evaluation seems needed, additional studies based on symptom subtype can be undertaken. The diagnosis and management of IBS should be based on the most recent and highest-quality evidence, and the Rome II Diagnostic Criteria should be used to guide the diagnosis of IBS 1.
From the Research
Diagnosis of Symptoms
To diagnose a 3-month history of symptoms, it is essential to consider various factors, including the clinical presentation, degree of inflammation, and systems involved.
- The diagnosis is often disease-specific, and treatment varies based on the specific disease, its stage of presentation, and patient symptoms 2.
- A guideline for the treatment and prevention of infections associated with immunosuppressive therapy for autoimmune diseases proposes a risk assessment and prevention strategy, including characterization of the disease, understanding of the mechanism of action of the immunosuppressive drug, and knowledge of previous infections 3.
Considerations for Immunosuppression
When considering immunosuppression, it is crucial to recognize the increased risk of infection, which may be present globally or only for specific agents, varying widely depending on the pharmacological class and even within the same class.
- The prevention strategy and clinical management need to be individually tailored, taking into account several key factors, including laboratory test results, vaccine administration, and monitoring of clinical signs and symptoms 3, 4.
- Systematic screening for latent or chronic infections prior to initiation and close monitoring of patients during immunomodulatory or immunosuppressive therapy are necessary to reduce morbidity and mortality 4.
Treatment Options
Treatment options for infections associated with immunosuppressive therapy include the use of antimicrobial agents, such as ciprofloxacin, which has been shown to be effective against gram-negative pathogens 5.
- Advances in immunosuppressive agents based on signal pathways have led to the development of new therapeutic agents, including JAK inhibitors and mTOR inhibitors, which have shown good therapeutic effects 6.