A source for healthcare professionals to access the latest data and information on the diagnosis, treatment and management of patients with gut related disorders


Differential diagnosis of irritable bowel syndrome

Dr Fermín Mearin-Manrique

Director of the Department of Gastroenterology, Institute of Functional and Motor Digestive Disorders, Barcelona, Spain

The diagnosis of irritable bowel syndrome (IBS) should be based on the characteristic symptoms outlined in the Rome IV criteria; however, it does not eliminate the need to perform the relevant explorations to confirm the differential diagnosis from other pathologies that can manifest themselves in a similar fashion.1,2

The diagnosis of IBS with diarrhoea or functional diarrhoea gives a differential diagnosis from chronic diarrhoea.1,2 Causes of infection (especially Giardia lamblia), the consumption of drugs that may have diarrhoea as a side effect (eg. metformin, colchicine), poor absorption of some sugars (lactose, fructose, sorbitol), insufficient pancreatic exocrine function, intestinal bacteria overgrowth disorder, and diarrhoea due to bile acid malabsorption must also be considered.1,2 Coeliac inflammatory bowel disease, and microscopic colitis (lymphocytic colitis and collagenous colitis) should similarly be taken into account.3,4 Colon cancer can also present in a similar way, and the clinical suspicion or requirement for further diagnostic investigation depends on the patient’s age as well as the presence or absence of symptoms or warning signs.1


Dr Fermín Mearin-Manrique is Director of the Department of Gastroenterology at the Teknon Medical Center, Barcelona, Spain. Doctor Cum Laude at the Autonomous University of Madrid, Dr Mearin-Manrique has experience in professional and research centre of excellence including the Mayo Clinic in the United States and the Hospital Vall d'Hebron in Barcelona. He is the ex-President of the Spanish Gastroenterology Association and the author of numerous renowned Spanish and international scientific papers, such as the Rome IV criteria.


1. Lacy B et al. Gastroenterology 2016;150:1393–1407.
2. Mearin F & Lacy B. Neurogastroenterol Motil 2012;24:791–801.
3. Ford A et al. Arch Intern Med 2009;169:651–658.
4. Guagnozzi D et al. Aliment Pharmacol Ther 2016;43:851–862.

Job number: JB57410GBj Date of Preparation: June 2019

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