IBS is considered to be a functional disorder. What does this mean? How does this relate to Mrs. Clarke's history of having a colonoscopy and her physician's order for a hydrogen breath test and measurements of anti-tTG?
What will be an ideal response?
• IBS is a functional disorder, which means that other GI diseases that present with similar symptoms (celiac, Crohn's, infectious diarrhea, etc.) are ruled out before diagnosing the patient with irritable bowel syndrome.
• A colonoscopy is an endoscopic exam of the colon, or the large intestine. This exam would see diverticulitis or polyps, which are pre-cancerous growths that may develop into colon cancer. Mrs. Clarke's colonoscopy was normal, indicating that diverticulosis, diverticulitis, and ulcerative colitis/Crohn's disease (inflammatory bowel diseases) are ruled out. In addition, the colonoscopy is a part of screening to rule out colon cancer.
• The hydrogen breath test is used to detect lactose malabsorption or small intestinal bacterial overgrowth. Lactose malabsorption is often associated with IBS. Baseline hydrogen on the breath is measured. The patient then consumes 25-50 g of lactose and breath hydrogen concentration is measured after 3-8 hours. >20 ppm indicates lactose malabsorption. Depending on the outcome of the scheduled hydrogen breath test, positive results may aid in assistance with nutrition therapy.
• Anti-tTG are antibodies associated with celiac disease (CD). The identification of antibodies is commonly used to diagnose CD. A negative result for these antibodies would rule out CD for Mrs. Clarke. Celiac disease is also associated with IBS so the American College of Gastroenterology recommends that all patients be screened for celiac disease as a component of differentiating the diagnosis from IBS.
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