Diagnosis of Irritable Bowel Syndrome: a Systematic Review

Jung Ho Park; Jeong-Sik Byeon; Woon-Geon Shin; Young Hun Yoon; Jae Hee Cheon; Kwang Jae Lee; Hyojin Park

doi:10.4166/kjg.2010.55.5.308

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Park, Byeon, Shin, Yoon, Cheon, Lee, Park, and The Korean Society of Neurogastroenterology and Motility: Diagnosis of Irritable Bowel Syndrome: a Systematic Review

Review

Korean J Gastroenterol 2010;55(5):308-315.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.55.5.308

Diagnosis of Irritable Bowel Syndrome: a Systematic Review

Jung Ho Park, M.D., Jeong-Sik Byeon, M.D.^∗, Woon-Geon Shin, M.D.^†, Young Hun Yoon, M.D.^‡, Jae Hee Cheon, M.D.^‡, Kwang Jae Lee, M.D.^§, Hyojin Park, M.D.^‡,; The Korean Society of Neurogastroenterology and Motility

Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea

^∗Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea

^†Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea

^‡Department of Medicine, Yonsei University College of Medicine, Seoul, Korea

^§Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea

Correspondence to: Hyojin Park, M.D. Department of Internal Medicine, Kangnam Severance Hospital, Yonsei University College of Medicine, 712, Eonguro, Gangnam-gu, Seoul 135-720, Korea Tel: +82-2-3497-3310, Fax: +82-2-3463-3882 E-mail: HJPARK21@yuhs.ac

Abstract

Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder characterized by abdominal discomfort, bloating, and disturbed defecation. Patients with IBS have a tendency to visit physicians more frequently than those without IBS, thus annual economic consequences of IBS in the Western countries are substantial. Therefore, guidelines for the diagnosis and treatment of IBS patients have been designed to give a fa-vored effect on the Department of Gastroenterology's overall performance. A variety of criteria have been developed to identify a combination of symptoms to diagnose IBS, including Manning and Rome I, II, and III criteria. Overall, Manning's criteria had a pooled sensitivity and specificity, 78% and 72%, respectively. In addition, the Rome I criteria had a sensitivity and specificity, 71% and 85%, respectively. However, none described the accuracy of Rome II and III yet. Alarm features such as rectal bleeding and nocturnal pain offer little discriminative value in separating patients with IBS from those with organic diseases. Even though anemia and weight loss have poor sensitivity for organic diseases, they offer very good specificity. Since specific biomarker of IBS is not yet available, diagnostic tests are frequently performed to exclude organic diseases. However, the accuracy of diagnostic tests is disappointing. CBC, chemistry, thyroid function test, stool exam, ultrasonography, hydrogen breath test, erythrocyte sedimentation rate, and C-reactive protein have all very limited accuracy in discriminating IBS from organic diseases. This systemic review is targeted to establish the strategy of IBS treatment, which is very necessary for the current clinical practice.

Keywords: Irritable bowel syndrome, Diagnosis

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Fig. 1.

Flow chart for searching strategy.

Table 1.

Summary of Diagnostic Criteria Used to Define Irritable Bowel Syndrome

Diagnostic criteria	Symptoms, signs, and laboratory investigations included in criteria
Manning (1978)	IBS is defined as the symptoms given below with no duration of symptoms described. The number of symptoms that need to be present to diagnose IBS is not reported in the paper, but a threshold of three positive is the most commonly used:
	1. Abdominal pain relieved by defecation
	2. More frequent stools with onset of pain
	3. Looser stools with onset of pain
	4. Mucus per rectum
	5. Feeling of incomplete emptying
	6. Patient-reported visible abdominal distension
Rome I (1990)	Abdominal pain or discomfort relieved with defecation, or associated with a change in stool frequency or consistency, PLUS two or more of the following on at least 25% of occasions or days for three months:
	1. Altered stool frequency
	2. Altered stool form
	3. Altered stool passage
	4. Passage of mucus
	5. Bloating or distension
Rome II (1999)	Abdominal discomfort or pain that has two of three features for 12 weeks (need not be consecutive) in the last one year:
	1. Relieved with defecation
	2. Onset associated with a change in frequency of stool
	3. Onset associated with a change in form of stool
Rome III (2006)	Recurrent abdominal pain or discomfort three days per month in the last three months associated with two or more of:
	1. Improvement with defecation
	2. Onset associated with a change in frequency of stool
	3. Onset associated with a change in form of stool

IBS, irritable bowel syndrome.

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