Evaluation of Patients with IBS

1- Food history including type and amount

2- Routine blood tests; CBC, complete metabolic panel, thyroid function test, ESR, CRP, Helicobacter pylori antibody

3- Lactose tolerance test or lactose breath test in most if not all

4- Lactulose breath test to evaluate for SIBO in selected cases

5- Fructose breath test in selected patients.

6- Celiac Sprue blood test at least 2, TTGAB and gliadin antibody in selected cases

7- Stool guiac for occult blood

8- Colonoscopy in patients over 50 and those with Alarm symptoms.

Colonoscopy even if negative can identify hemorrhoids, polyps, diverticulosis, circular muscle hypertrophy, angiodysplasia, and microscopic colitis ( 5% of IBS diarrhea).