Diagnoses that fool the scope: The great imitators of IBS

When it’s not what it seems

Many patients may present with underlying conditions that mimic IBS and require different testing and treatment.

Board-certified gastroenterologist Dr. Emily Ward from GutsyRX calls these conditions the great imitators of IBS.

As many as 50% of patients referred to a specialist clinic with 'IBS' are ultimately diagnosed with something else, Dr. Ward estimated in her clinical experience.

Why misdiagnosis happens

IBS is usually diagnosed positively – based on Rome IV Criteria, history, and minimal testing. But time constraints, incomplete histories, and a fragmented care model mean many patients do not get the thorough evaluation they need. Alarm symptoms are sometimes missed, biopsies are skipped, or assumptions are made too quickly.

Dr. Ward emphasizes the importance of slowing down, asking the right questions, and being intentional about endoscopy and histology to uncover the real cause.

Common IBS imitators

If a patient is not responding to IBS therapy, or something about their story does not add up, these conditions are worth considering:

• Microscopic colitis

• Bile acid malabsorption

• Seronegative celiac disease

• Crohn’s disease (especially isolated ileal disease)

• Chronic infections, such as Giardia

• Disaccharidase deficiencies (e.g. lactase, sucrase)

• Exocrine pancreatic insufficiency

• Atrophic gastritis with hypochlorhydria

Women and patients with IBS-D or mixed subtypes are more likely to have an alternative diagnosis.

A 'whole story' mindset

Dr. Ward encourages clinicians to look beyond checklists and see the whole patient story – because with careful attention and targeted testing, we can avoid misdiagnosis and deliver better care.

Want to go deeper? Watch the full webinar above and download the quick reference guide.

For patients with confirmed IBS, timely access to effective therapy matters

Once you have ruled out the great imitators and made a confident diagnosis, referring through our secure online form connects your IBS patients with gut-directed hypnotherapy – quickly and confidently.

The form takes just a minute to complete and ensures your patients can start on the right care pathway without unnecessary delays, giving them timely access to an evidence-based, supportive therapy that complements your clinical care.

Refer via the online form or bookmark it for later