When is a colonoscopy necessary in IBS

When is a colonoscopy necessary in diagnosing IBS? 

A colonoscopy is routinely recommended only in patients older than 50 years of age as per the colon cancer screening guidelines. A colonoscopy for those younger than 50 years of age may be appropriate in patients with significant diarrhea or refractory symptoms or if other alarm features are present (see Question 20). It should be noted that if a colonoscopy is performed on a patient with suspected IBS with diarrhea, random biopsies should be obtained to exclude microscopic colitis, as a recent study found microscopic colitis present in 2.5% of patients older than the age of 35.

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