A Boy With Frequent Diarrhea: Differentiating IBS From IBD

Lindsey G. Albenberg, DO; Wenjing Zong, MD


March 18, 2019

Editorial Collaboration

Medscape &

A Review of IBS

IBS is a functional gastrointestinal disorder that is thought to be a result of changes in the brain-gut axis. Children with IBS may have a heightened sensation of normal stimuli in the bowel. Psychological distress, mucosal inflammation, and alterations in the gut microbiome have all been shown to be related to IBS symptoms. Most children will grow and develop normally, although they often do not feel well. Some children may lose weight because they eat less to avoid abdominal symptoms. They may also be embarrassed and even depressed by their symptoms.

The diagnosis of IBS, as outlined in the Rome IV criteria, should be based on a thorough medical history and physical examination. Laboratory evaluation to screen for infection and inflammation may be performed. Other tests may include urinalysis, stool sample for blood or bacteria/parasites, hydrogen breath test, abdominal imaging, and endoscopic evaluation.

Table 2. Rome IV Criteria for IBS[7]

  1. Abdominal pain at least 4 days per month for at least 3 months associated with two or more of the following:

    • Related to defecation

    • Associated with a change in frequency of stool

    • Associated with a change in form of stool

  2. In children with constipation, the pain does not resolve with resolution of the constipation.

  3. After appropriate evaluation, the symptoms cannot be fully explained by another medical condition.

IBS Treatment

Treatment is focused on restoring normal function. It may include dietary changes, medication, probiotics, and stress management. At this time, there are limited data on treatment options. A 2014 systematic review and meta-analysis concluded that peppermint oil was effective in reducing pain.[8] There are data supporting probiotics as well.[7,9] An elimination diet reducing the intake of FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) may provide efficacy.[9.10] Behavioral treatments can also be recommended.[11]

Follow CHOP on Twitter
Follow Medscape on Facebook, Twitter, Instagram, and YouTube