MEDLINE Abstracts: Diagnosis of IBS

[falcon]

FYI

MEDLINE Abstracts: Diagnosis of IBS


What's new concerning the diagnosis of irritable bowel syndrome (IBS)?
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The Utility of Diagnostic Tests in Irritable Bowel Syndrome Patients: A Systematic Review
Cash BD, Schoenfeld P, Chey WD
Am J Gastroenterol. 2002;97:2812-2819

Objective: The aim of this study was to determine the pretest probability of organic GI disease and the accuracy of diagnostic tests for organic GI disease in patients who meet symptom-based criteria for irritable bowel syndrome (IBS).
Methods: After a comprehensive literature search for studies examining the accuracy of diagnostic tests for organic GI disease among patients who meet symptom-based criteria for IBS, two independent observers qualitatively assessed the methodology of selected studies and extracted data. Data on the pretest probability of organic GI disease in this population and the accuracy of currently recommended diagnostic tests were converted to descriptive tables.
Results: Among patients meeting symptom-based criteria for IBS, the pretest probability of inflammatory bowel disease, colorectal cancer, or infectious diarrhea is less than 1%. Currently recommended diagnostic tests rarely identify organic GI disease in patients fulfilling symptom-based criteria for IBS. However, the pretest probability of celiac disease in patients meeting symptom-based criteria for IBS was 10 times higher than the prevalence of celiac disease in the general population.
Conclusions: There is insufficient evidence to recommend the routine performance of a standardized battery of diagnostic tests in patients who meet symptom-based criteria for IBS. Based upon the increased pretest probability of celiac disease, routine performance of serological tests for celiac disease may be useful in this patient population, though additional study is needed in this area.




Utility of the Rome I and Rome II Criteria for Irritable Bowel Syndrome in US Women
Chey WD, Olden K, Carter E, Boyle J, Drossman D, Chang L
Am J Gastroenterol. 2002;97:2803-2811

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 with IBS was identified and interviewed by telephone screening of a national, random digit dialing sample of households. A parallel national survey of adult females was conducted to determine the lifetime prevalence of IBS in U.S. women. Screening and interviews were conducted by experienced, female interviewers. IBS was defined by variations on the Rome I/II criteria.
Results: In the national community sample, lifetime IBS prevalence was 5.4% using Rome II. Full interviews were completed in 1,014 IBS patients. In the IBS sample, Rome I was significantly more sensitive than Rome II (84% vs 49%, p < 0.001). There was 47% agreement between Rome I and II. Of patients with IBS by Rome I, 58% met Rome II. Only 17.7% did not meet either Rome I or II.
Conclusions: Rome I was more sensitive than Rome II in this community sample of female IBS patients. Rome I/II do not necessarily identify the same IBS patients. These findings have important implications for clinical research in IBS patients and raise questions about whether the Rome II criteria are sensitive enough to be useful in clinical practice.




New Developments in the Diagnosis and Treatment of Irritable Bowel Syndrome
Longstreth GF, Drossman DA
Curr Gastroenterol Rep. 2002;4:427-434

Irritable bowel syndrome (IBS) is a common disorder with major health status and economic effects. Symptom criteria are of paramount importance in diagnosis, but differences among the Manning, Rome I, and Rome II criteria may lead to variable identification of people with the disorder. Practice guidelines are based on evidence and, to a greater degree, on consensus; therefore, experts vary on the specifics of ordering particular diagnostic tests. There is an overlap of IBS symptoms with those of celiac sprue, and selected patients should be tested for the latter disease. Symptom confusion with biliary pain and overlap with chronic pelvic pain could contribute to the predisposition of IBS patients to undergo cholecystectomy and hysterectomy. Development and documentation of effective therapy has been difficult, but depending on the selection of subgroups, there is evidence for usefulness of smooth muscle relaxants, loperamide, and antidepressants. Various forms of psychological therapy and new serotonin-modulating agents seem especially promising. The placebo effect of the physician-patient relationship has important therapeutic benefit.




Clinical Assessment of Irritable Bowel Syndrome
Lembo TJ, Fink RN
J Clin Gastroenterol. 2002;35:S31-S36

Because irritable bowel syndrome (IBS) is a prevalent cause of visits to the gastroenterologist, it is extremely important to have accurate guidelines for the diagnosis. During the clinical assessment of IBS, the physician must look for the gastrointestinal symptoms, extraintestinal symptoms, and psychological history that are commonly associated with IBS. There are three diagnostic criteria that may be used in the IBS diagnosis: Manning, Rome I, and Rome II. Although there is discrepancy about which is most effective, we recommend that the Rome II be used in clinical practice. To confidently diagnose IBS, the physician must rule out organic disease as a cause of symptoms. This can be done by evaluating the patient's symptoms and screening for "red flags." The diagnostic strategy for IBS involves a thorough evaluation of the patient: taking a patient history, performing a physical exam, and performing the appropriate diagnostic tests when necessary.




Use of Surrogate Markers of Inflammation and Rome Criteria to Distinguish Organic From Nonorganic Intestinal Disease
Tibble JA, Sigthorsson G, Foster R, Forgacs I, Bjarnason I
Gastroenterology. 2002;123:450-460

Background & Aims: Differentiating symptoms of irritable bowel syndrome (IBS) from those of organic intestinal disease is a familiar problem for physicians. The aim of this study was to assess the sensitivity, specificity, and odds ratios (ORs) of fecal calprotectin, small intestinal permeability, Rome I criteria, and laboratory markers of inflammation (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], blood count) in distinguishing organic from nonorganic intestinal disease.
Methods: A total of 602 new referrals to a gastroenterology clinic who had symptoms suggestive of IBS or organic intestinal disease were studied for these parameters. All patients underwent invasive imaging (barium/endoscopic examination) and other investigations as appropriate, with physicians blinded to the results of fecal calprotectin and intestinal permeability.
Results: A total of 263 patients were diagnosed with organic disease and 339 with IBS. At 10 mg/L, the sensitivity and specificity of calprotectin for organic disease were 89% and 79%, respectively, and that of intestinal permeability for small intestinal disease were 63% and 87%, respectively. Sensitivity of positive Rome criteria for IBS was 85% with a specificity of 71%. An abnormal calprotectin test had an OR for disease of 27.8 (95% confidence interval [CI], 17.6-43.7; P < 0.0001) compared with ORs of 4.2 (95% CI, 2.9-6.1; P < 0.0001) and 3.2 (95% CI, 2.2-4.6; P < 0.0001) for elevated CRP and ESR values. An abnormal permeability test gave an OR of 8.9 (95% CI, 5.8-14.0; P < 0.0001) for small intestinal disease. The OR for IBS with positive Rome criteria was 13.3 (95% CI, 8.9-20.0).
Conclusions: Fecal calprotectin, intestinal permeability, and positive Rome I criteria provide a safe and noninvasive means of helping differentiate between patients with organic and nonorganic intestinal disease.




Rectal Distention Testing in Patients With Irritable Bowel Syndrome: Sensitivity, Specificity, and Predictive Values of Pain Sensory Thresholds
Bouin M, Plourde V, Boivin M, et al
Gastroenterology. 2002;122:1771-1777

Background & Aims: Visceral hypersensitivity was detected in patients with functional gastrointestinal disorders and has been proposed as a biological marker of irritable bowel syndrome (IBS). The purpose of this study was to assess the sensitivity, specificity, and the predictive values of pain thresholds evaluated by rectal distention using an electronic barostat in patients with or without IBS and in control subjects.
Methods: Patients were diagnosed according to Rome II criteria. Rectal sensory thresholds were determined in 164 patients (86 IBS patients, 26 painless constipation, 21 functional dyspepsia, and 31 miscellaneous conditions) and in 25 normal controls. All subjects underwent a series of rectal isobaric distentions using an electronic barostat. The bag was progressively distended from 0 to 48 mm Hg and, in response to distention, subjects reported on discomfort or pain.
Results: Pain thresholds were lower in IBS patients (30.4 ± 6.7 mm Hg) compared with controls (44.5 ± 5), painless constipated (45.4 ± 5.3), functional dyspepsia (39.4 ± 7. , and miscellaneous patients (43.2 ± 5.5). At the level of 40 mm Hg, the sensitivity of the rectal barostat to identify IBS patients from normal subjects and non-IBS patients was 95.5% and its specificity was 71.8%. The positive predictive value was 85.4%. The negative predictive value was 90.2%.
Conclusions: Lowered rectal pain threshold is a hallmark of IBS patients. Rectal barostat testing is useful to confirm the diagnosis of IBS and to discriminate IBS from other causes of abdominal pain.




Diagnosis of Irritable Bowel Syndrome
Olden KW
Gastroenterology. 2002;122:1701-1714

Irritable bowel syndrome (IBS) is the most common disorder seen in gastroenterology practice. It is also a large component of primary care practices. Although the classic IBS symptoms of lower abdominal pain, bloating, and alteration of bowel habits is easily recognizable to most physicians, diagnosing IBS remains a challenge. This is in part caused by the absence of anatomic or physiologic markers. For this reason, the diagnosis of IBS currently needs to be made on clinical grounds. A number of symptom-based diagnostic criteria have been proposed over the last 15 years. The most recent of these, the Rome II criteria, seem to show reasonable sensitivity and specificity in diagnosing IBS. However, the role of the Rome II criteria in clinical practice remains ill defined. A review of the literature shows that, in patients with no alarm symptoms, the Rome criteria have a positive predictive value of approximately 98%, and that additional diagnostic tests have a yield of 2% or less. Diagnostic evaluation should also include a psychosocial assessment specifically addressing any history of sexual or physical abuse because these issues significantly influence management strategies and treatment success.

[kelvinsteele]

I just thought it and really like it thanks.

[falcon]

your welcome.

This was from 2002 and more is known now. They are also using rome lll now.

[falcon]

your welcome.

This was from 2002 and more is known now. They are also using rome lll now.