Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.563
Peer-review started: July 31, 2021
First decision: October 22, 2021
Revised: November 8, 2021
Accepted: December 10, 2021
Article in press: December 10, 2021
Published online: January 14, 2022
Processing time: 164 Days and 15.9 Hours
The diagnosis of irritable bowel syndrome (IBS) depends on symptoms, while the accuracy of symptom-based criteria is poor. Alarm symptoms have long been applied in the diagnosis of IBS. However, no study has explored the predictive value of alarm symptoms in suspected IBS patients based on the latest Rome IV criteria.
The symptoms of IBS overlap with those of many organic diseases, and IBS lacks specific diagnostic tests and biomarkers. There are differences in previous research results on the predictive value of alarm symptoms in IBS, and there is no relevant study based on Rome IV. Evaluating the value of alarm symptoms provides guidance for clinical evaluation of the risk of organic diseases in suspected IBS patients, giving necessary auxiliary examination and correct diagnosis of IBS.
The objective was to investigate the predictive value of alarm symptoms in suspected IBS patients based on Rome IV. Furthermore, an IBS prediction model was established to guide the clinical and scientific work of IBS.
This cross-sectional study was conducted at three academic urban tertiary care centers to ensure the sample size, sample representativeness and reliability of the results. Eligible patients completed questionnaires (paper version or electronic version), underwent laboratory tests, and were assigned to the IBS or organic disease group according to colonoscopy findings and pathology results. Investigators did not give any intervention to the patients and inspectors, and the results were more in line with clinical practice.
Anemia, fecal occult blood, unintended weight loss, female sex and marital status were independently correlated with organic disease. The positive predictive value (PPV) of alarm symptoms for organic disease was highest for anemia, fecal occult blood and unintended weight loss, and it was 100% when these three factors were combined. The PPV and missed diagnosis rate for diagnosing IBS were 91.67% and 74.77% when all alarm symptoms were combined with Rome IV and 92.09% and 34.10% when only fecal occult blood, unintended weight loss and anemia were combined with Rome IV, respectively.
Alarm symptoms, especially fecal occult blood, unintended weight loss and anemia, have a high predictive value for organic disease in suspected IBS patients based on Rome IV. The presence of those alarm symptoms suggests that further examination may be needed, but they are not recommended as exclusion criteria for diagnosing IBS.
By collecting large-scale, high-quality and national multicenter data, a simple, practical and efficient IBS diagnosis model can be further constructed. Of course, we should continue to deepen the research on the etiology and mechanism of IBS, actively look for specific biomarkers and/or diagnostic tests and achieve a more accurate diagnosis of IBS.