Applying Case Definition Criteria to Irritable Bowel Syndrome

Abstract

Irr itable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract characterized by recurrent episodes of abdominal pain or discomfort along with changes in frequency or consistency of the stool in the absence of an organic etiology. The condition is heterogeneous, exhibiting variability in the frequency of symptoms reported within and between males and females. 1 The pathophysiological mechanisms of IBS are not completely understood. Alterations in gut motility, visceral perception, and central processing of pain and motor function due to abnormalities in the enteric and central nervous system are believed to account for symptoms of IBS. 2 The brain-gut axis and biopsychosocial model have been used to explain how intrinsic and extrinsic stimuli modulate disease expression. 3,4 It is unknown whether IBS is primarily a disorder of abnormal perception to a normal stimulus, or a disorder of normal perception to an abnormal physiologic sensory stimulus. Since no structural abnormalities or biochemical markers characterize IBS, diagnosis is based on the presence of clinical symptoms. 2 Symptom-based diagnostic criteria have been established to create uniformity in reporting and enhance diagnostic accuracy. Objective: The quality of documentation of signs and symptoms and validation of the diagnosis of irritable bowel syndrome (IBS) according to case definition criteria of Manning, Rome I and Rome II in an office setting has not been previously described.We sought to identify and validate cases of IBS based on the Manning, Rome I and Rome II diagnostic criteria in a rural practice setting. Original Research Conclusions:Only a small percentage of IBS cases with assigned diagnostic codes met case definition criteria for IBS.There were low concordance rates among the three diagnostic criteria applied.

The Search for Reliable Biomarkers of Disease in Multiple Chemical Sensitivity and Other Environmental Intolerances

“…This condition, estimated to have 5–25% prevalence in the world population, again more frequently reported for the female gender, is not presently clarified in terms of patho-physiological mechanism, and is diagnosed exclusively according to symptom classification-based guidelines and exclusion of other known causes of organic pathologies, such as celiac or colon cancer diseases [82]. IBS is a heterogeneous condition presenting very frequent co-morbidity with other disturbances, mainly migraine headache, fibromyalgia and chronic pelvic pain, anxiety and depression, somatization, stress sensitivity, with consequent low quality-of-life scores bearing relevant socioeconomic impact [83].…”

Presacral schwannoma treated as irritable bowel syndrome

“…Rectal examination is useful in detecting retrorectal masses 4. Misinterpretation of symptoms and diagnosis of irritable bowel syndrome has been reported in many pelvic pathologies,5 6 and even on strict adherence to Manning and Rome criteria I and II for case definition of irritable bowel syndrome the percentage of concordance is low 7. The diagnosis of irritable bowel syndrome is a diagnosis of exclusion, especially when red flag signs are present.…”

Irritable bowel syndrome and inflammatory bowel disease: infectious gastroenteritis-related disorders?

“…Those studies routinely used the Manning, Rome I, or Rome II criteria to diagnosis the tested subjects, of which the Rome II criteria have been mainly used in more recent epidemiological studies. The earlier Manning criteria are more general and less restrictive than the more recent Rome I and Rome II criteria, and several studies have revealed that the prevalence rates of IBS evaluated by the Manning criteria are relatively higher than those evaluated by the Rome criteria [5,25,26]. Data from recent epidemiological studies evaluated by the Rome II criteria are summarized in Table 1 [25,[27][28][29][30][31][32][33][34][35][36][37].…”