Enhancing Diagnostic Performance of Symptom-Based Criteria for Irritable Bowel Syndrome by Additional History and Limited Diagnostic Evaluation

Sood, Ruchit; Camilleri, Michael; Gracie, David J.; Gold, Matthew; To, Natalie; Law, Graham; Ford, Alexander C

doi:10.1038/ajg.2016.308

Cited by 46 publications

(56 citation statements)

References 42 publications

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“…Symptom-based criteria to diagnose specific FGIDs and rule out organic disease have limited value but there is circumstantial evidence that specific features of the patient history, and a limited diagnostic evaluation that may include calprotectin or C-reactive protein may substantially improve the sensitivity, specificity and positive and negative likelihood ratios 46. Recent studies have suggested that biomarkers might be useful to categorise FGID cohorts.…”

Section: Role Of Patient History and Biomarkers To Augment Future Catmentioning

confidence: 99%

Inconsistent symptom clusters for functional gastrointestinal disorders in Asia: is Rome burning?

Holtmann

Talley

2018

Gut

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Section: Role Of Patient History and Biomarkers To Augment Future Catmentioning

confidence: 99%

Inconsistent symptom clusters for functional gastrointestinal disorders in Asia: is Rome burning?

Holtmann

Talley

2018

Gut

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“…The discriminatory accuracy of the two models, as measured by the AUC, were good at 0.77 and 0.79 for the Canadian and UK models respectively. This compares with positive LRs of 3.35–3.87 in two previous validation studies of the Rome III criteria, which was enhanced to over 7 by incorporating various combinations of levels of somatic symptom reporting, absence of nocturnal stool passage, and normal blood results in one of these studies …”

Section: Discussionmentioning

confidence: 73%

“…The prevalence of IBS in the UK study, as defined by the reference standard, was 27.5% ( n = 99). Compared with those who did not undergo colonoscopy, patients undergoing colonoscopy had a higher BMI, but there were no other significant differences between the two groups, including the number of patients who had IBS according to the latent class model [94 (26.1%) of 360 patients colonoscoped, vs. 147 (22.9%) of 642 not colonoscoped, P = 0.29].…”

Section: Resultsmentioning

confidence: 95%

“…The local ethics committee approved the study, with recruitment commencing in January 2014, and continuing through to December 2015. Again, the methodology and study population used have been described in detail elsewhere . We used these patients to validate the latent class model derived from the patients contained in the Canadian dataset.…”

Section: Methodsmentioning

confidence: 99%

“…The current preferred approach to making a diagnosis of IBS is via symptom‐based criteria, of which the Rome IV criteria are the gold‐standard, although their accuracy has yet to be assessed independently . Their predecessor, the Rome III criteria, were rarely used in routine clinical care, partly as a consequence of their perceived complexity, but also because they performed only modestly in diagnosing IBS . Proposed biomarkers for IBS do not perform any better than symptom‐based criteria, or are considered too invasive or too complex to be used beyond a research setting or a tertiary care centre .…”

Section: Introductionmentioning

confidence: 99%

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Derivation and validation of a diagnostic test for irritable bowel syndrome using latent class analysis

Sood

Gracie

Gold

et al. 2017

Aliment Pharmacol Ther

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Summary Background The accuracy of symptom‐based diagnostic criteria for irritable bowel syndrome (IBS) is modest. Aims To derive and validate a new test that utilises latent class analysis. Methods Symptom, colonoscopy, and histology data were collected from 1981 patients and 360 patients in two cohorts referred to secondary care for investigation of their gastrointestinal symptoms in Canada and the UK, respectively. Latent class analysis was used to identify naturally occurring clusters in patient‐reported symptoms in the Canadian dataset, and the latent class model derived from this was then applied to the UK dataset in order to validate it. Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated for the latent class models. Results In the Canadian cohort, the model had a sensitivity of 44.7% (95% CI 40.0–50.0) and a specificity of 85.3% (95% CI 83.4–87.0). Positive and negative LRs were 3.03 (95% CI 2.57–3.56) and 0.65 (95% CI 0.59–0.71) respectively. A maximum positive LR of 3.93 was achieved following construction of a receiver operating characteristic curve. The performance in the UK cohort was similar, with a sensitivity and specificity of 52.5% (95% CI 42.2–62.7) and 84.3% (95% CI 79.3–88.6), respectively. Positive and negative LRs were 3.35 (95% CI 2.38–4.70) and 0.56 (95% CI 0.45–0.68), respectively, with a maximum positive LR of 4.15. Conclusions A diagnostic test for IBS, utilising patient‐reported symptoms incorporated into a latent class model, performs as accurately as symptom‐based criteria. It has potential for improvement via addition of clinical markers, such as coeliac serology and faecal calprotectin.

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Diagnosis and Treatment of Irritable Bowel Syndrome

Camilleri

2021

JAMA

Self Cite

175

135

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ImportanceThe prevalence of irritable bowel syndrome (IBS) in the United States is between 7% and 16%, most common in women and young people, with annual direct costs estimated at more than $1 billion dollars in the United States. Traditionally, the diagnosis of IBS has been based on the positive identification of symptoms that correlate with several different syndromes associated with disorders such as IBS diarrhea, IBS constipation, functional diarrhea, functional constipation, chronic functional abdominal pain, or bloating. Several peripheral and central mechanisms initiate gastrointestinal motor and sensory dysfunctions leading to IBS symptoms. Those dysfunctions may require evaluation in patients whose symptoms do not respond to first-line treatments.ObservationsValidation studies of consensus symptom-based criteria have identified deficiencies that favor a simpler identification of the predominant symptoms of abdominal pain, bowel dysfunction, and bloating and exclusion of alarm symptoms such as unintentional weight loss, rectal bleeding, or recent change in bowel function. Symptom-based diagnosis of IBS is enhanced with additional history for symptoms of somatoform and psychological disorders and alarm symptoms, physical examination including digital rectal examination, and screening tests to exclude organic disease (by measuring hemoglobin and C-reactive protein concentrations). The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders. For patients who do not respond to those IBS treatments, testing for specific functional disorders may be required in a minority of patients with IBS. These disorders include rectal evacuation disorder, abnormal colonic transit, and bile acid diarrhea. Their identification is followed by individualized treatment, such as pelvic floor retraining for rectal evacuation disorders, sequestrants for bile acid diarrhea, and secretory agents for constipation, although there is only limited evidence that this individualized management approach is effective.Conclusions and RelevanceAdvances in the identification of specific dysfunctions as causes of individual symptoms in the “IBS spectrum” leads to the potential to enhance the diagnosis and management of symptoms for the majority of patients for whom first-line therapies of IBS and management of comorbid psychological disorders are insufficient.

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Enhancing Diagnostic Performance of Symptom-Based Criteria for Irritable Bowel Syndrome by Additional History and Limited Diagnostic Evaluation

Cited by 46 publications

References 42 publications

Inconsistent symptom clusters for functional gastrointestinal disorders in Asia: is Rome burning?

Inconsistent symptom clusters for functional gastrointestinal disorders in Asia: is Rome burning?

Derivation and validation of a diagnostic test for irritable bowel syndrome using latent class analysis

Diagnosis and Treatment of Irritable Bowel Syndrome

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