PATIENT PRESENTATION MARKER

IBS-D symptoms

What this marker measures

The degree to which Rome IV criteria are met/not met for the diarrhoea subtype of irritable bowel syndrome. This does not constitute a diagnosis.

Health categories/Interpretations informed by this marker

Gut function
● Pancreatic insufficiency: diarrhoea is a common clinical feature of pancreatic exocrine insufficiency. Patients with the diarrhoea subtype of irritable bowel syndrome (IBS-D) may have pancreatic insufficiency.^1–3

Clinical features
‍● Lower GI symptoms: IBS-D symptoms are a commonly-reported lower GI symptom cluster that can affect quality of life.
^‍

Interpreting the result

PRESENT

Questionnaire responses indicate abdominal pain on 1 or more days per week for 6 months or more, linked to bowel motions, with stools that most often change to loose or watery during pain. This is consistent with the Rome IV criteria for IBS, with a diarrhoea-type stool pattern.

NOT PRESENT

Questionnaire responses do not meet the criteria for Present.

Patient management insights

DIETARY STRATEGIES

Add psyllium husk: psyllium husk may reduce stool frequency, improve stool consistency, and reduce urgency in chronic diarrhoea.⁴
GRADE D

CLINICAL MANAGEMENT

Trial pancreatic enzyme replacement therapy (PERT) (Present, with borderline low pancreatic elastase): PERT may improve diarrhoea in patients with borderline pancreatic elastase.^1–3
GRADE D

Tips for patients discussion

"Your questionnaire responses show a pattern of tummy pain alongside loose or watery stools. This is common and can affect how you feel day to day. We'll look at your other results together to work out the best next step, which may include a fibre supplement such as psyllium husk."

Source references for all clinical associations, interpretation definitions, and patient management insights on this card.

1. Mathew, A., Fernandes, D. & Andreyev, H. J. N. What is the significance of a faecal elastase-1 level between 200 and 500 μg/g? Frontline Gastroenterol 14, 371–376 (2023).
2. Campbell, J. A. et al. Should we investigate gastroenterology patients for pancreatic exocrine insufficiency? A dual centre UK study. J Gastrointestin Liver Dis 25, 303–309 (2016).
3. Evans, K. E. et al. Pancreatic insufficiency in adult celiac disease: do patients require long-term enzyme supplementation? Dig Dis Sci 55, 2999–3004 (2010).
4. Qvitzau, S., Matzen, P. & Madsen, P. Treatment of chronic diarrhoea: loperamide versus ispaghula husk and calcium. Scand J Gastroenterol 23, 1237–1240 (1988).