Persistent diarrhoea in a young woman

doi:10.1136/bmj.b3369

Published 16 September 2009, doi:10.1136/bmj.b3369
Cite this as: BMJ 2009;339:b3369

Endgames

Case Report

Persistent diarrhoea in a young woman

Rene Ramnarace, specialist registrar, James Ricketts, foundation year 1, medicine, Harry Dalton, consultant gastroenterologist

¹ Department of Medicine, Division of Gastroenterology, Royal Cornwall Hospital, Truro TR1 3LJ, Cornwall

Correspondence to: R Ramnarace rene_ramnarace@yahoo.co.uk

The first 150 words of the full text of this article appear below.

A 25 year old woman presented with repetitive diarrhoea associatedwith a mucous discharge and abdominal pain for the past sixmonths. She passed five to 10 stools a day, with urgency anda sensation of incomplete emptying. Her symptoms were aggravatedby episodes of interpersonal stress and improved after defecation.She had no history of nocturnal diarrhoea, rectal bleeding,or weight loss. Simple analgesia improved her symptoms. Herillness was eroding her confidence and negatively affectingher social life. Clinical examination, including a rectal examination,was normal.

1 What is the likely diagnosis?

2 What investigation, if any,would confirm the diagnosis?

3 Which symptoms should promptfurther evaluation?

4 What new treatments are available?

1 Irritable bowel syndrome with predominance of diarrhoea.

2The Rome III criteria encourage clinicians to make a positivediagnosis of irritable bowel syndrome on the basis of validatedsymptom criteria rather than make . . . [Full text of this article]