Summary
Background
Studies suggest that the positive predictive value of the Rome II criteria for diagnosing irritable bowel syndrome can be enhanced by excluding red flag symptoms suggestive of organic diseases.
Aim
We assessed the utility of red flags for detecting organic diseases in patients diagnosed irritable bowel syndrome by their physicians.
Methods
Systematic chart reviews were completed in 1434 patients with clinical diagnoses of irritable bowel syndrome, abdominal pain, diarrhoea or constipation, who also completed questionnaires to identify Rome II criteria for irritable bowel syndrome and red flag symptoms.
Results
The overall incidence of gastrointestinal cancer was 2.5% (but 1.0% in those with irritable bowel syndrome), for inflammatory bowel disease 2.0% (1.2% in irritable bowel syndrome), and for malabsorption 1.3% (0.7% in irritable bowel syndrome). Red flags were reported by 84% of the sample. The positive predictive value of individual red flags for identifying organic disease was 7–9%. Excluding any patient with a red flag improved the agreement between Rome II and clinical diagnosis by a modest 5%, but left 84% of patients who were diagnosed with irritable bowel syndrome by their physicians, without a diagnosis.
Conclusions
Red flags may be useful for identifying patients who require additional diagnostic evaluation, but incorporating them into the Rome criteria would not improve sensitivity and would result in too many missed irritable bowel syndrome diagnoses.
#1William E. Whitehead(UNC: University of North Carolina at Chapel Hill)H-Index: 102
#2Rona L. Levy(UW: University of Washington)H-Index: 40
Last. Douglas A. Drossman(UNC: University of North Carolina at Chapel Hill)H-Index: 103
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Summary Aims : To determine what constitutes usual medical care for irritable bowel syndrome, which patient characteristics influence choice of treatment and how satisfied patients are with care. Methods : Patient encounters in a health maintenance organization were prospectively monitored to identify visits coded irritable bowel syndrome, abdominal pain, constipation or diarrhoea. Within 2 weeks these patients were sent postal questionnaires (n = 1770, 59% participation) to assess patient chara...
Objective: The diagnostic value of the addition of alarm symptoms in distinguishing functional from organic gastrointestinal disease remains uncertain. We aimed to establish the value of alarm features in differentiating between organic disease and irritable bowel syndrome (IBS) and functional dyspepsia (FD). Methods: A total of 568 consecutive patients (63% female; mean age 44.7 years) completed a detailed symptom questionnaire and then received a complete diagnostic workup, as required. Questi...
Background: The new guidelines for diagnosing irritable bowel syndrome (IBS) in clinical practice recommend the use of the Rome II criteria. In this study the agreement between general practitioners (GPs) and the Rome II criteria for diagnosing of IBS and functional bowel disorders (FBD) is examined. Methods: Consecutive patients in general practice were asked to report on abdominal complaints, for which they had consulted or wanted to consult a GP. Patients with such complaints completed a ques...
#1Douglas A. Drossman(UNC: University of North Carolina at Chapel Hill)H-Index: 103
#2Michael Camilleri(UNC: University of North Carolina at Chapel Hill)H-Index: 146
Last. William E. Whitehead(UNC: University of North Carolina at Chapel Hill)H-Index: 102
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Abstract The irritable bowel syndrome (IBS) is part of the larger group of functional gastrointestinal (GI) disorders that, despite differences in location and symptom patterns, share common features with regard to their motor and sensory physiology, central nervous system (CNS) relationships, and the approach to patient care. 1 IBS is a functional bowel disorder characterized by symptoms of abdominal pain or discomfort that is associated with disturbed defecation. 2 This disorder is highly prev...
#2Kevin Olden(UNC: University of North Carolina at Chapel Hill)H-Index: 1
Last. Lin Chang(UCLA: University of California, Los Angeles)H-Index: 73
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Abstract OBJECTIVES: Using interview data from a large, community-based sample of American women, we assessed the lifetime prevalence of irritable bowel syndrome (IBS) using questions consistent with the Rome II criteria, determined the sensitivity of Rome I and II in women diagnosed with IBS by their community physician, and identified whether there are differences in the patients identified by Rome I versus II. METHODS: A geographically diverse national probability sample of women diagnosed wi...
Irritable bowel syndrome affects 10% of adults with an unexplained female predominance. Although only a few people see their family doctor, the disease causes reduced quality of life and represents a multi-billion pound health-care problem. The disorder clusters in families, which is possibly because of intra-familial learning and a genetic predisposition. Visceral hypersensitivity is a key feature in most patients. Results of imaging studies of regional cerebral blood flow during rectal distens...
Abstract OBJECTIVE: Our aim was to examine the predictive value of the Rome criteria and absence of so-called “red flags” of clinical practice for diagnosing irritable bowel syndrome. Red flags were relevant abnormalities on physical examination, documented weight loss, nocturnal symptoms, blood in stools, history of antibiotic use, and family history of colon cancer. METHODS: In retrospective studies, 98 patients who had one or more Rome criteria and lacked red flags were identified by chart re...
The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised. A functional bowel disorder (FBD) is diagnosed by ...
Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new ev...
#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 ...
#2Ayesha Shah(Translational Research Institute)H-Index: 12
Last. Gerald Holtmann(Translational Research Institute)H-Index: 73
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BACKGROUND Patients presenting with gastrointestinal symptoms can be challenging in terms of determining etiology and management strategies. Identifying likely organic pathology is important since it can be treated and may result in further, long-term harm to the patient if not treated. Currently, organic pathology is often identified via invasive procedures such as endoscopy or referral to a medical imaging service. We report on an approach that offers a first step at identifying patients with ...
Last. Baha Moshiree(UNC: University of North Carolina at Chapel Hill)H-Index: 2
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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...
Last. Imran Aziz(University of Sheffield)H-Index: 21
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Background There is little data on the diagnostic yield of colonoscopy in patients with symptoms compatible with functional bowel disorders (FBDs). Previous studies have only focused on diagnostic outcomes of colonoscopy in those with suspected irritable bowel syndrome using historic Rome I-III criteria, whilst having partially assessed for alarm features and shown markedly conflicting results. There is also no colonoscopy outcome data for other FBDs, such as functional constipation or functiona...
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder which accounts for a substantial proportion of a gastroenterologist’s time in the outpatient clinic. However, there is variability in approaches to diagnosis and investigation between physicians, dependent on expertise. Many patients express disappointment over the lack of a patient-centred approach. Consequently, there have been calls for the care of patients with IBS to be standardised, a process which aims to prom...
Last. Max Schmulson(UNAM: National Autonomous University of Mexico)H-Index: 23
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BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystemic involvement. Gastrointestinal (GI) manifestations are frequent but functional gastrointestinal disorders (FGIDs) have scarcely been studied in SLE. To determine the prevalence of FGIDs and their potential risk factors in SLE female patients vs controls. METHODS: Systemic lupus erythematosus patients meeting the American College of Rheumatology (ACR) criteria and controls completed the Rome III questionnair...
Irritable bowel syndrome (IBS) is a well diagnosed disease, thoroughly attributed to series of symptoms criteria that embrace a broad range of abdominal complainers. Such criteria help to diagnosis the disease and can guide controlled clinical trials to seek new therapeutic agents. Accordingly, a verity of mechanisms and pathophysiological conditions including inflammation, oxidative stress, lipid peroxidation and different life styles are involved in IBS. Predictably, diverse therapeutic approa...
Aim. To justify the need to include colorectal cancer (CRC) in the circle of differential diagnostic search for suspected irritable bowel syndrome (IBS). Background. In accordance with the latest Rome IV criteria for IBS, its diagnosis is mainly based on the assessment of clinical symptoms and objective examination data with a very limited list of additional studies. In this case, colonoscopy for suspected IBS is performed only in patients aged over 50 years old, provided a hereditary predisposi...
#1Theodore Katz(MedStar Georgetown University Hospital)
#2Janet Smereck(MedStar Georgetown University Hospital)H-Index: 4
A frequent clinical question when caring for patients with chronic abdominal pain is when to obtain imaging or repeat imaging. Little consensus guidance exists on this issue. As a significant proportion of patients presenting with chronic abdominal pain have functional syndromes rather than underlying organic disease, providers must be judicious with imaging decisions. The choice of imaging modality should be tailored to assessing for a particular diagnosis, rather than as a screening tool. “Red...
