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. 2011 Nov 4;108(44):751–760. doi: 10.3238/arztebl.2011.0751

Table 3. Important differential diagnoses of IBS in patients with chronic abdominal IBS-like symptoms.

Main symptom Important differential diagnoses (among others)
Diarrhea Chronic infectious enterocolitis, e.g., bacterial, parasitic, or viral (e.g., cytomegalovirus [CMV] with or without immunosuppression) pathogens; fungal infections (e.g., histoplasmosis in HIV)
Crohn’s disease
Ulcerative colitis
Celiac disease/sprue
Bacterial infection of the small intestine
Symptomatic carbohydrate malabsorption (e.g., lactose or fructose malabsorption)
Microscopic colitis
Bile acid malabsorption
Clostridium difficile colitis
Motility disorders of the small intestine
Exocrine pancreatic insufficiency
Autonomic neuropathy (diabetes)
Drug intolerance
Food allergy
Hyperthyroidism
Incontinence
Functionally active neuroendocrine tumor
Colorectal carcinoma (paradoxical diarrhea)
Pain Crohn’s disease
Ulcer
Gastrointestinal tumor
Mesenteric ischemia
Porphyria
Endometriosis
Ovarian tumor
Small-bowel stenoses (e.g., radiogenic, adhesions)
Postoperative functional impairment (e.g., adhesions)
C1-esterase inhibitor deficiency
Intestinal motility disorders (e.g., chronic intestinal pseudo-obstruction)
Constipation Adverse drug effect
Hypothyroidism
Colorectal carcinoma (alternating with paradoxical diarrhea in patients with symptoms of stenosis)
Chronic diverticulitis
Motility disorders, e.g., neuropathic colonic paresis (slow-transit constipation)
Functional or structural defecation disorders
Bloating, distension Bacterial infection (small-intestinal bacterial overgrowth; often secondary, e.g., in small-bowel diverticula, motility disorders, etc.)
Carbohydrate malabsorption (e.g., symptomatic lactose and/or fructose malabsorption)
Postoperative functional disorders (e.g., adhesions)