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Abstract
Objective. Guidelines for the management of irritable bowel syndrome (IBS) encourage a positive diagnosis, but some evidence suggests organic disease may be missed unless investigations are performed. We examined yield of colonoscopy in a cohort of secondary care patients meeting criteria for IBS. Materials and methods. Demographic data, symptoms and findings at colonoscopy were recorded prospectively in consecutive, unselected adults with gastrointestinal (GI) symptoms compatible with IBS according to the Rome III criteria. Prevalence of organic GI disease was compared between those meeting criteria for IBS, according to the presence or absence of co-existent alarm features, and by IBS subtype. Results. A total of 559 patients met Rome III criteria for IBS, of whom 423 reported ≥1 alarm feature and 136 none. There was a significantly higher prevalence of organic GI disease among those reporting alarm features (117 [27.7%]), compared with those without (21 [15.4%]) (p = 0.002). In the latter group of 136 patients, Crohn’s disease was the commonest finding (10 [7.4%] subjects), followed by coeliac disease (4 [2.9%] subjects), and microscopic colitis (3 [2.2%] subjects). Regardless of presence or absence of alarm features, patients with constipation-predominant IBS were less likely to exhibit organic GI disease than those with diarrhea-predominant or mixed IBS (12.7% vs. 32.1% and 23.8%, p = 0.006). Conclusions. One in six patients with symptoms compatible with IBS without alarm features in this selected group exhibited organic GI disease following investigation. Assessment of alarm features in a comprehensive history is vital to reduce diagnostic uncertainty that can surround IBS.
Acknowledgement
We are grateful to June Urquhart for entry of questionnaire data and administering questionnaires to patients attending clinic, and Sandra Arthur for administering questionnaires to patients attending clinic. Canadian Association of Gastroenterology (the study sponsor had no role in the study design, collection, analysis, or interpretation of data). P Patel, P Bercik, DG Morgan, C Bolino, MI Pintos-Sanchez, P Moayyedi, and AC Ford conceived and drafted the study. AC Ford, C Bolino, and MI Pintos-Sanchez collected all data. P Patel and AC Ford analysed and interpreted the data. P Moayyedi provided statistical advice and support. AC Ford drafted the manuscript. All authors have approved the final draft of the manuscript.
Declaration of interest: Guarantor of the article: ACF is guarantor. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.