Systematic review with meta-analysis: the accuracy of diagnosing irritable bowel syndrome with symptoms, biomarkers and/or psychological markers.

Published on Sep 1, 2015in Alimentary Pharmacology & Therapeutics7.515
· DOI :10.1111/APT.13283
Ruchit Sood13
Estimated H-index: 13
(University of Leeds),
David J. Gracie16
Estimated H-index: 16
(University of Leeds)
+ 1 AuthorsAlexander C. Ford86
Estimated H-index: 86
(University of Leeds)
Summary Background Irritable bowel syndrome (IBS) is a complex, heterogeneous disease which can be challenging to diagnose. No study has identified and assessed the accuracy of all available methods of diagnosing IBS. Aim To conduct a systematic review of the literature to identify and assess accuracy of symptom-based diagnostic criteria, biomarkers, psychological markers or combinations thereof. Methods MEDLINE, EMBASE and EMBASE Classic were searched (until April 2015) to identify studies reporting accuracy of available methods to diagnose IBS in adult populations. Eligible studies assessed accuracy of these diagnostic tests against an accepted reference standard. Data were extracted to calculate positive and negative likelihood ratios, with 95% confidence intervals (CIs), of the diagnostic test utilised. Where more than one study used the same test, data were pooled in a meta-analysis. Results Twenty-two studies (7106 patients) were eligible. Positive and negative likelihood ratios of the current gold standard, the Rome III criteria, were 3.35 (95% CI: 2.97–3.79) and 0.39 (95% CI: 0.34–0.46), similar to other symptom-based criteria. Eleven biomarkers performed no better than symptom-based criteria. Psychological markers performed well in one study. Five different combinations were assessed. The best in terms of positive likelihood ratio was faecal calprotectin, intestinal permeability and Rome I criteria (26.4; 95% CI: 11.4–61.9), and in terms of negative likelihood ratio serum-based biomarkers and psychological markers (0.18; 95% CI: 0.12–0.25). Conclusions Symptom-based diagnostic criteria, biomarkers and psychological markers performed modestly in predicting IBS. Combining symptoms with markers appears more effective, and may represent the way forward in the diagnosis of IBS.
📖 Papers frequently viewed together
3,903 Citations
130 Citations
20152.74PLOS ONE
15 Authors (Mark Pimentel, ..., Christopher Chang)
94 Citations
#1Uday N. Shivaji (St James's University Hospital)H-Index: 3
#2Alexander C. Ford (St James's University Hospital)H-Index: 86
Aim To examine beliefs about irritable bowel syndrome (IBS) management among primary care physicians. Background There have been considerable advances in evidence synthesis concerning management of IBS in the last five years, with guidelines for its management in primary care published by the National Institute for Health and Care Excellence (NICE). Methods This was a cross-sectional web-based questionnaire survey of 275 primary care physicians. We emailed a link to a SurveyMonkey questionnaire,...
13 CitationsSource
#1Natasha A. Koloski (University of Newcastle)H-Index: 26
#2Michael Jones (Macquarie University)H-Index: 137
Last. Nicholas J. Talley (University of Newcastle)H-Index: 183
view all 4 authors...
Summary Background While the Rome III classification recognises functional constipation (FC) and constipation predominant IBS (IBS-C) as distinct disorders, recent evidence has suggested that these disorders are difficult to separate in clinical practice. Aim To identify whether clinical and lifestyle factors differentiate Rome III-defined IBS-C from FC based on gastrointestinal symptoms and lifestyle characteristics. Method 3260 people randomly selected from the Australian population returned a...
43 CitationsSource
#1Preeti Patel (University of Leeds)H-Index: 21
#2Premysl Bercik (McMaster University)H-Index: 57
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 7 authors...
SummaryBackground Psychological factors may influence persistence and perceived severity of symptoms in irritable bowel syndrome (IBS). Literature suggests that somatisation is associated with IBS. However, the relationship between IBS subtype, symptoms of IBS and somatisation is unclear. Aim To examine this issue in a large cohort of secondary care patients. Methods Demographic and gastrointestinal (GI) symptom data were collected from 4224 adult patients via the Rome III questionnaire. Somatis...
47 CitationsSource
#1H. C. Chang (FJU: Fu Jen Catholic University)H-Index: 1
#2A. M F YenH-Index: 1
Last. Y. M. Lin (FJU: Fu Jen Catholic University)H-Index: 1
view all 9 authors...
Irritable bowel syndrome and the incidence of colorectal neoplasia: a prospective cohort study with community-based screened population in Taiwan
6 CitationsSource
#1Michael Camilleri (Mayo Clinic)H-Index: 146
#2Andrea Shin (Mayo Clinic)H-Index: 20
Last. Alan R. Zinsmeister (Mayo Clinic)H-Index: 139
view all 11 authors...
Background A valid biomarker is ‘an indicator of normal biologic or pathogenic processes, or pharmacological responses to a therapeutic intervention’. There is no validated biomarker for irritable bowel syndrome (IBS). The aim of the study was to assess ability of three quantitative traits to identify treatable processes to discriminate between IBS-diarrhea (IBS-D) patients, IBS-constipation (IBS-C) patients and healthy volunteers (HV). Methods In 30 HV, 30 IBS-C patients and 64 IBS-D patients, ...
39 CitationsSource
#1C. Canavan (University of Nottingham)H-Index: 10
#2Joe West (University of Nottingham)H-Index: 72
Last. Timothy R. Card (University of Nottingham)H-Index: 54
view all 3 authors...
SummaryBackground Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal system affecting a large number of people worldwide. Whilst it has no attributable mortality, it has substantial impact on patients' quality of life (QoL) and is associated with considerable healthcare resource use. Aim To review the economic impact of IBS, firstly on the individual, secondly on healthcare systems internationally and thirdly to society. Methods Appropriate databases were sea...
207 CitationsSource
#1Ruchit Sood (St James's University Hospital)H-Index: 13
#2Graham R. Law (University of Leeds)H-Index: 28
Last. Alexander C. Ford (St James's University Hospital)H-Index: 86
view all 3 authors...
IBS is a prevalent condition worldwide that incurs substantial health-care costs. The condition can be difficult to diagnose owing to is multifactorial aetiology. Here, the authors provide an overview of the current approaches available to diagnose IBS, including symptoms, symptom-based criteria, biomarkers and psychological markers. Future directions for the field are also discussed.
36 CitationsSource
#1Alexander C. Ford (St James's University Hospital)H-Index: 86
#2Paul Moayyedi (McMaster University)H-Index: 115
Last. Eamonn Martin QuigleyH-Index: 120
view all 9 authors...
Irritable bowel syndrome (IBS) and chronic idiopathic constipation ((CIC) also referred to as functional constipation) are two of the most common functional gastrointestinal disorders worldwide. IBS is a global problem, with anywhere from 5 to 15 % of the general population experiencing symptoms that would satisfy a defi nition of IBS ( 1,2 ). In a systematic review on the global prevalence of IBS, Lovell and Ford ( 1 ) documented a pooled prevalence of 11 % with all regions of the world suff er...
383 CitationsSource
#1Magdy El-Salhy (University of Bergen)H-Index: 29
#2Odd Helge Gilja (Haukeland University Hospital)H-Index: 59
Last. Trygve Hausken (Haukeland University Hospital)H-Index: 62
view all 5 authors...
Background and Aim. Chromogranin A (CgA) is a common marker for endocrine cells. The density of duodenal CgA cells is reduced in patients with irritable bowel syndrome (IBS). Methods. The present study was undertaken to evaluate the density of duodenal CgA as a biomarker for the diagnosis of IBS. Two hundred and three patients with IBS were recruited (180 females and 23 males; mean age, 36 years; range, 18–66 years). The control group comprised 86 healthy subjects without gastrointestinal compla...
30 CitationsSource
#1Jennifer DevlenH-Index: 3
Last. Alan C. Moss (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 55
view all 6 authors...
Background The aim of this study was to describe the impacts of inflammatory bowel disease (IBD) from the patients’ perspective, and to inform the development of a conceptual model.
66 CitationsSource
Cited By55
#1Christopher J BlackH-Index: 13
#2Orla Craig (Leeds Teaching Hospitals NHS Trust)H-Index: 1
Last. Alexander C. FordH-Index: 86
view all 4 authors...
Objectives Despite being proposed 4 years ago, there has been no independent validation study of the Rome IV criteria for IBS. We assessed their performance for the diagnosis of IBS in secondary care and compared them with the previous iteration, the Rome III criteria. Design We collected complete symptom data from consecutive adult patients with suspected IBS referred to a single UK clinic. All subjects underwent relatively standardised workup, with assessors blinded to symptom status. The refe...
6 CitationsSource
#1H. Jervoise N. Andreyev (University of Nottingham)H-Index: 2
#2A Lalji (The Royal Marsden NHS Foundation Trust)H-Index: 12
Last. L. WedlakeH-Index: 16
view all 15 authors...
BACKGROUND The underlying mechanisms of chemotherapy-induced gastrointestinal (GI) symptoms are poorly researched. This study characterised the nature, frequency, severity and treatable causes for GI symptoms prospectively in patients undergoing chemotherapy for GI malignancy. METHODS Patients receiving chemotherapy for a GI malignancy were assessed pre-chemotherapy, then monthly for 1 year using the Gastrointestinal Symptom Rating Scale, a validated patient-reported outcome measure. Patients wi...
3 CitationsSource
#1Imran Aziz (University of Sheffield)H-Index: 21
#2Magnus Simrén (UNC: University of North Carolina at Chapel Hill)H-Index: 78
Irritable bowel syndrome (IBS) is a common functional bowel disorder characterised by symptoms of recurrent abdominal pain associated with a change in bowel habit. This condition is one of the most frequent reasons to seek a gastroenterology consultation in primary and secondary care. The diagnosis of IBS is made by identifying characteristic symptoms, as defined by the Rome criteria, and excluding organic gastrointestinal diseases that might otherwise explain these symptoms. Organic conditions ...
5 CitationsSource
#1Brian E. LacyH-Index: 54
#2Mark PimentelH-Index: 61
Last. Baha Moshiree (UNC: University of North Carolina at Chapel Hill)H-Index: 2
view all 7 authors...
Irritable bowel syndrome (IBS) is a highly prevalent, chronic disorder that significantly reduces patients' quality of life. Advances in diagnostic testing and in therapeutic options for patients with IBS led to the development of this first-ever American College of Gastroenterology clinical guideline for the management of IBS using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Twenty-five clinically important questions were assessed after a comprehensi...
35 CitationsSource
#1Hirokazu Fukui (Hyogo College of Medicine)H-Index: 33
#2Akifumi NishidaH-Index: 1
Last. Hiroto Miwa (Hyogo College of Medicine)H-Index: 54
view all 18 authors...
Irritable bowel syndrome (IBS) is diagnosed by subjective clinical symptoms. We aimed to establish an objective IBS prediction model based on gut microbiome analyses employing machine learning. We collected fecal samples and clinical data from 85 adult patients who met the Rome III criteria for IBS, as well as from 26 healthy controls. The fecal gut microbiome profiles were analyzed by 16S ribosomal RNA sequencing, and the determination of short-chain fatty acids was performed by gas chromatogra...
6 CitationsSource
#1Funmilola A. Ayeni (UI: University of Ibadan)H-Index: 9
#2Tolulope Elizabeth Fadeyi (UI: University of Ibadan)
The association of the gut microbiota with many diseased and healthy state is currently of global interest. Depression is a disorder that is etiologically heterogeneous. There is a correlation between gut microbiota, immune responses, behaviour and pathophysiology of depression. These shows the link of microbiome and mental health, which point to a possible future of manipulation of gut microbiota for better health. This mini review compiled some existing literature on the relationship between d...
Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder, which can affect all members of a society, regardless of age, sex, race or socioeconomic status. Because of its high prevalence and chronic nature, it represents a significant economic burden. In fact, these patients have a relevant impairment of their quality of life, which limits their work productivity and daily social activities, especially when it is associated with other disorders, such as anxiety and depression...
3 CitationsSource
Irritable bowel syndrome (IBS) is one the most frequent and common functional gastrointestinal disorders that has a multifactorial etiopathogenesis. Multiple biomarkers have been tested in search for a reliable and specific biomarker, but there is not yet a specific biomarker for IBS. The aim of this study was to evaluate two biomarkers of different putative pathways of the pathogenesis of IBS: the monocyte chemotactic protein-1 (MCP-1) and nitrotyrosine, in order to establish their role as pote...
#1Vincent C.H. Chung (CUHK: The Chinese University of Hong Kong)H-Index: 23
#2Charlene Hl Wong (CUHK: The Chinese University of Hong Kong)H-Index: 1
Last. Justin C.Y. Wu (CUHK: The Chinese University of Hong Kong)H-Index: 69
view all 9 authors...
BACKGROUND AND AIM: Treatment options for functional dyspepsia (FD) refractory to pharmacological treatments are limited but the effectiveness of electroacupuncture (EA) is uncertain. We assessed the effectiveness of EA combined with on-demand gastrocaine. METHODS: We conducted a single-center, assessor-blind, randomized parallel-group 2-arm trial on Helicobacter pylori negative FD patients of the postprandial distress syndrome subtype refractory to proton pump inhibitor, prokinetics, or H2 anta...
3 CitationsSource
#1Alonso Carrasco-Labra (McMaster University)H-Index: 3
#2Lyubov Lytvyn (McMaster University)H-Index: 26
Last. William D. CheyH-Index: 78
view all 5 authors...
Background & Aims The evaluation of patients with chronic watery diarrhea represents a diagnostic challenge for clinicians because organic causes, including inflammatory bowel disease, microscopic colitis, and chronic infection, must be differentiated from functional diarrhea and diarrhea-predominant irritable bowel syndrome. The purpose of this review is to summarize the available evidence on the usefulness of diagnostic tests in such patients. Methods We searched MEDLINE and EMBASE via OVID, f...
24 CitationsSource