ROSH Gastrointestinal Practice Exam

In a patient with chronic abdominal pain, which finding suggests a diagnosis of irritable bowel syndrome?

1. Nocturnal or progressive abdominal pain

2. Weight loss

3. Improvement with defecation

4. Decreased hemoglobin

The correct answer is: Improvement with defecation

The finding that suggests a diagnosis of irritable bowel syndrome (IBS) in a patient with chronic abdominal pain is improvement with defecation. IBS is characterized by abdominal pain that is often relieved after passing a stool. This symptom is a hallmark of the condition and differentiates it from other gastrointestinal disorders, where pain may not improve with bowel movements. The pathophysiology of IBS involves alterations in gut motility and sensitivity, leading to pain that is often related to bowel habits. Therefore, if a patient reports that their abdominal pain decreases following defecation, it strongly suggests the presence of IBS. In contrast, nocturnal or progressive abdominal pain is generally not associated with IBS and may indicate other conditions that require more in-depth evaluation. Similarly, weight loss and decreased hemoglobin are concerning symptoms that could point to more serious gastrointestinal conditions, such as malignancies or inflammatory conditions, rather than IBS, which typically does not lead to significant weight changes or systemic symptoms.