A Boy With Frequent Diarrhea: Differentiating IBS From IBD

Lindsey G. Albenberg, DO; Wenjing Zong, MD


March 18, 2019

Editorial Collaboration

Medscape &

Management Approach for IBD

On the basis of these findings, the patient was diagnosed with IBD, likely ulcerative colitis. Management of pediatric IBD should be based on clinical symptoms, histologic findings, and location and severity of disease. In general, the management approach will involve both pharmacologic and nutritional therapy.

Case Continued: Clinical Course

The patient was started on anti-tumor necrosis factor (TNF)-alpha therapy for his ulcerative colitis after corticosteroid and mesalamine failed. After 2 years, he remains well without bloody stools, abdominal pain, and nocturnal stools, and his growth remains appropriate for age. His blood work and stool calprotectin are normal. A surveillance colonoscopy was normal. However, he continues to experience three to four loose, nonbloody bowel movements daily. The bowel movement pattern is tolerable for him and does not affect his ability to attend school and participate in activities. This led to a diagnosis of IBS.

Today, he remains in remission with anti-TNF treatment for his IBD. He has also learned over the years how to cope with his baseline IBS and does not require any supportive medications.