A 28-year-old female presents with alternating episodes of crampy lower abdominal pain, bloating, and irregular bowel habits (diarrhea alternating with constipation) over the past 9 months. Her symptoms improve markedly following defecation. Complete blood count, inflammatory markers (ESR, CRP), fecal calprotectin, and celiac serologies are all completely normal. What is the most likely diagnosis under the Rome IV criteria?

Answer and explanation

Correct answer: B. Irritable Bowel Syndrome (IBS)

  1. Step 1: The Rome IV criteria define Irritable Bowel Syndrome (IBS) as recurrent abdominal pain on average at least 1 day per week in the last 3 months, associated with two or more of: related to defecation, associated with a change in frequency of stool, or associated with a change in form/appearance of stool.
  2. Step 2: The absence of alarm symptoms (weight loss, nocturnal diarrhea, anemia, elevated fecal calprotectin) confirms functional IBS.
Answer
Irritable Bowel Syndrome (IBS).
Why not the others: 'Crohn's Disease' and 'Ulcerative Colitis' are inflammatory bowel diseases characterized by elevated fecal calprotectin, mucosal ulcerations, rectal bleeding, and systemic inflammation; 'Microscopic Colitis' presents with persistent watery secretory diarrhea in older patients with normal endoscopic mucosa but histological intraepithelial lymphocytic infiltration.

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