American Board of Internal Medicine (ABIM) Certification Practice Exam

What screening is advised for patients with irritable bowel syndrome with diarrhea?

1. Stool culture

2. Colonoscopy

3. Serum tissue transglutaminase testing

4. Upper GI series

The correct answer is: Serum tissue transglutaminase testing

Screening for patients with irritable bowel syndrome with diarrhea (IBS-D) typically includes testing for celiac disease, making serum tissue transglutaminase testing the advised option. This is important because IBS-D can have symptoms overlapping with celiac disease, such as chronic diarrhea and abdominal discomfort. By testing for celiac disease, clinicians can rule it out as a potential underlying cause of the patient's symptoms. Individuals presenting with diarrhea, bloating, and abdominal pain warrant further investigation, and finding celiac disease can lead to significant dietary changes that alleviate symptoms. While other diagnostic tests, such as stool cultures, colonoscopies, and upper GI series, may be indicated in specific situations or to rule out other conditions, they are not part of the routine screening for these patients. Hence, serum tissue transglutaminase testing serves as a practical approach in the context of IBS-D symptomatology.