Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome

Whitehead, William E.; Palsson, Olafur S.; Feld, Andrew D.; Levy, Rona L.; Korff, Michael Von; Turner, Marsha J.; Drossman, Douglas A.

doi:10.1111/j.1365-2036.2006.02956.x

Cited by 106 publications

(93 citation statements)

References 11 publications

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“…14 In the present study, frequencies of reporting "red flag" symptoms (eg, blood in stools and unintended weight loss) were concordant with previous reports. 8,21 It is not surprising that the frequency of family history of any GI cancer in our findings was relatively high in each group (25.5 to 28.6%, Table 5) since gastric and colon cancers are very common in the Japanese population. 22 Notably, the red flags are not automatically cause for alarm signs.…”

Section: Discussionmentioning

confidence: 92%

“…Briefly, the "red flag" questions include history for the past 3 months of fever, weight loss, cancer in family members, blood mixed with stool, anemia and change in bowel habit after age 50. 8 Red flags may be useful for identifying patients who require additional diagnostic evaluation in the clinical settings. However, it has been investigated that incorporating them into the Rome II criteria did not improve sensitivity and resulted in too many missed diagnoses of IBS.…”

Section: Introductionmentioning

confidence: 99%

“…However, it has been investigated that incorporating them into the Rome II criteria did not improve sensitivity and resulted in too many missed diagnoses of IBS. 8 Previously, we have developed and validated the Japanese translated version of the Rome II modular questionnaire based on the former diagnostic criteria for IBS. 9 There are a few studies to investigate prevalence of FGIDs using the Rome III criteria in Japan.…”

Section: Introductionmentioning

confidence: 99%

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Validity and Reliability of the Japanese Version of the Rome III Diagnostic Questionnaire for Irritable Bowel Syndrome and Functional Dyspepsia

Kanazawa

Nakajima

Oshima

et al. 2015

J Neurogastroenterol Motil

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Background/AimsReliable diagnostic instruments for measuring the presence of functional gastrointestinal disorders based on the Rome III criteria have been lacking in Japan. The aims of the present study were to translate and validate the Rome III diagnostic questionnaire which was widely used in Western countries. MethodsThe original version of Rome III diagnostic questionnaire was translated from English into Japanese through 3 independent forward translations, resolution, back translation and reconciliation of the differences. Forty-nine patients with irritable bowel syndrome (IBS), 32 patients with functional dyspepsia (FD) and 56 subjects without any current GI symptoms as controls were recruited from three hospitals located in different regions of Japan and completed the IBS and FD diagnostic modules twice within 14 days. Kappa statistic was used to assess test-retest reliability. The sensitivity and specificity of each diagnostic module for distinguishing IBS or FD patients from controls was tested. Olafur Palsson. Professor Fukudo received a research grant from Kao and Astellas. He also received lecture fees from Abbott Japan, Dainippon-Sumitomo, and Astellas. Professor Drossman is a President of the Rome Foundation that created the Rome III criteria and he receives a stipend for this work. He also receives royalties for publication of the Rome III book. Professors Whitehead and Palsson received research grants from Ironwood Pharmaceuticals, Takeda Pharmaceuticals, and Salix Pharmaceuticals. Professor Whitehead is a consultant to Ono Pharma USA. Author contributions: Motoyori Kanazawa participated in study design, data collection, data analysis, and preparation of the manuscript; Shigemi Nakajima participated in data collection; Tadayuki Oshima participated in data collection; William E Whitehead participated in study design and preparation of the manuscript; Ami D Sperber, Olafur S Palsson and Douglas A Drossman participated in preparation of the manuscript; Hiroto Miwa participated in study design and data collection; and Shin Fukudo participated as the guarantor of this paper, and he participated in study design, data collection, data analysis, and manuscript preparation. ORCID: Motoyori Kanazawa, http://orcid.org/0000-0003-1953-3336. Motoyori Kanazawa, et al Journal of Neurogastroenterology and Motility 538 ResultsMedian kappa statistics were 0.63 for the translated IBS diagnostic module and 0.68 for the FD module. The sensitivity, specificity, and positive predict value of the IBS module against physician diagnosis was 61.2%, 100%, and 100% and those of the FD module was 53.2%, 98.2%, and 94.4%, respectively. Meanwhile, IBS patients were significantly more likely to report blood in stools compared to controls (18.4% vs 1.8%, P ＜ 0.01). ConclusionsThe IBS and FD diagnostic modules on the Japanese version of the Rome III diagnostic questionnaire are valid and reliable. Further studies are warranted to elucidate the diagnostic utility of the red flag questionnaire. (J Neurogastroenterol Motil 2015;21:5...

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Validity and Reliability of the Japanese Version of the Rome III Diagnostic Questionnaire for Irritable Bowel Syndrome and Functional Dyspepsia

Kanazawa

Nakajima

Oshima

et al. 2015

J Neurogastroenterol Motil

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show abstract

“…22 However, this was a small retrospective study, and the investigators did not attempt to separate nocturnal GI symptoms from other alarm symptoms, which are reported frequently by patients without organic disease. 29 Psychological or affective disorders have been shown to be strongly associated with IBS. 30 There was an improvement in diagnostic test accuracy when other investigators added these to a biomarker panel in a recent study.…”

Section: Diagnostic Performance Of Rome III Criteriamentioning

confidence: 99%

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

Sood

Camilleri

Gracie

et al. 2016

American Journal of Gastroenterology

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“…Alarm symptoms that should prompt investigation are: 5,6 A. iron deficiency anaemia B. blood in stool C. awakening at night with gastrointestinal symptoms D. unexplained weight loss E. family history of colorectal cancer F. age at onset over 50 years.…”

Section: Alarm Symptomsmentioning

confidence: 99%

Diagnostic tests: Imaging for chronic abdominal pain in adults

Mendelson

2015

Aust Prescr

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SUMMARYDiagnostic imaging is often not indicated in chronic abdominal pain. In particular, undifferentiated abdominal pain is rarely an indication for a CT scan.CT scanning is overused even when imaging is required. Other modalities may be preferable. A normal CT scan does not rule out cancer.Alarm symptoms, including anaemia, blood in the stool, waking at night with gastrointestinal symptoms, and weight loss, should be investigated. The most appropriate modality depends on the symptoms.Clinical information on request forms for CT scans should be specific and include the suspected condition as this helps the radiologist to determine an appropriate imaging protocol.outweighs the risk), CT should be performed and the patient reassured about the risks.

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Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome

Abstract: SUMMARY BackgroundStudies 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.

Cited by 106 publications

References 11 publications

Validity and Reliability of the Japanese Version of the Rome III Diagnostic Questionnaire for Irritable Bowel Syndrome and Functional Dyspepsia

Validity and Reliability of the Japanese Version of the Rome III Diagnostic Questionnaire for Irritable Bowel Syndrome and Functional Dyspepsia

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

Diagnostic tests: Imaging for chronic abdominal pain in adults

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