In a patient presenting with diarrhea that is worse when anxious, which diagnosis should be considered?

In patients who experience diarrhea that worsens in response to anxiety, irritable bowel syndrome (IBS) should be considered due to its strong association with stress and psychological factors. IBS is a functional gastrointestinal disorder characterized by symptoms like abdominal pain and altered bowel habits, which can be exacerbated by emotional stress or anxiety. The bidirectional communication between the gut and the brain explains why anxiety can trigger or worsen gastrointestinal symptoms, leading to increased bowel motility and diarrhea.

On the other hand, celiac disease, gastroenteritis, and bacterial infections typically present with more acute or specific symptoms related to the digestive process that is not primarily influenced by psychological factors. Celiac disease is an autoimmune condition characterized by an adverse reaction to gluten, leading to malabsorption and symptoms that are generally not connected to anxiety. Gastroenteritis often results from an infectious cause and tends to present with more severe acute symptoms that are not directly linked to emotional states. Similarly, bacterial infections typically manifest with signs of infection and do not have the same psychological component that can exacerbate symptoms like diarrhea. Therefore, IBS aligns with the presentation of diarrhea that worsens when the patient is anxious, making it the most fitting diagnosis.