Ford Bursey, MD
What is the accuracy of individual symptoms and combinations of clinical findings for diagnosing the irritable bowel syndrome (IBS)?
Included studies compared individual symptoms or combinations of clinical findings with investigational tests (colonoscopy, barium enema, or computed tomographic colography) for diagnosing IBS in unselected patients > 16 years of age who had lower gastrointestinal (GI) symptoms. IBS was defined as a functional disorder that was ruled out by the presence of organic lower GI disease. Lower GI symptoms had to be recorded before investigational tests were done. Outcomes were sensitivity, specificity, and positive and negative likelihood ratios (LRs).
MEDLINE (1950 to Jun 2008), EMBASE/Excerpta Medica (1980 to Jun 2008), and reference lists were searched for prospective, cross-sectional studies that included ≥ 50 patients. 10 studies (n = 2355) met the selection criteria: 1 was partly done in a primary care setting, and 9 were done in secondary care settings. 5 studies did independent, blinded comparisons of symptoms/findings with valid reference standards in ≥ 200 consecutive patients.
Pooled prevalence of IBS was 57%. Pooled data for diagnostic accuracy of 7 individual symptoms and 2 combinations of clinical findings are in the Table. 4 individual studies evaluated different statistical models of clinical findings; diagnostic accuracy varied.
Combinations of clinical findings had moderate sensitivity and specificity for diagnosing the irritable bowel syndrome; individual symptoms had limited accuracy.
Pooled test characteristics for diagnosing the irritable bowel syndrome*
*Diagnostic terms and abbreviations defined in Glossary.
†Maximum Kruis score = 87, based on patient-reported symptoms and physician-assessed signs.
‡Maximum Manning criteria = 6, based on the following: increased bowel movements or looser stools with onset of pain; abdominal bloating; abdominal pain relieved by evacuation; incomplete evacuation; or mucus per rectum.
Ford Bursey. Review: Combinations of clinical findings had moderate sensitivity and specificity for diagnosing the irritable bowel syndrome. Ann Intern Med. 2009;150:JC3–13. doi: 10.7326/0003-4819-150-6-200903170-02013
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Published: Ann Intern Med. 2009;150(6):JC3-13.
Gastroenterology/Hepatology, Irritable Bowel Syndrome.
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