Are Symptom-Based Diagnostic Criteria for Irritable Bowel Syndrome Useful in Clinical Practice?

Abstract

Accessible online at: www.karger.com/dig Symptoms consistent with irritable bowel syndrome (IBS) are reported by 10–20% of the Western population, but only a subgroup of people with IBS request medical attention and the majority of them are managed in primary care [1]. Considering that there is no biological marker for IBS, symptom-based diagnostic criteria have been developed in order to achieve a positive diagnosis of IBS and to ensure the homogeneity of patient populations in clinical research settings [1]. Kruis et al. [2] used a combination of clinical criteria and simple laboratory tests to develop a scoring system that differentiated IBS from organic disease in tertiary care patients. However, the scoring system and the addition of laboratory tests precluded a wide application, and pure symptom-based criteria were developed based on expert opinion and the Kruis scoring system. The criteria of Manning et al. [3] define IBS according to the presence of pain associated with altered bowel habit or defecation; the Rome I criteria added that these symptoms have to be continuous or recurrent for at least 3 months [4], and the Rome II revision added that symptoms have to have been present in the last year [5]. The sensitivity and specificity of these criteria in diagnosing IBS have been evaluated in a study on tertiary care patients [6]. This study has demonstrated a good sensitivity of the Manning criteria and a good specificity of the Rome I criteria. More recent articles have observed that the Rome II criteria are less sensitive compared to the Manning and Rome I criteria [7–9], but only a few studies have addressed the utility and applicability of these criteria in clinical practice [10, 11]. In this issue of Digestion, by selecting 68 general practitioners (GPs), 48 hospital gastroenterologists and 100 patients attending an outpatient clinic with a diagnosis of IBS made by experienced gastroenterologist, Lea et al. [12] have investigated the clinical utility of the Manning, Rome I and Rome II criteria. They report that only 20% of GPs know and 4% use these criteria, whereas 96% of consultants know and 70% use these criteria. The use of the Manning and Rome I criteria exclude from IBS diagnosis only 6 and 12%, respectively, of patients diagnosed in clinical practice. The Rome II criteria exclude 25 and 16%, respectively, of the patients with IBS according to the Manning and Rome I criteria. These results confirm the findings of previous studies that addressed the diagnosis of IBS in clinical practice [10, 11]. Gladman and Gorard [10] selected 137 GPs and 167 consultants and reported that 21 and 12% of GPs and 81 and 83% of consultants had heard of the Manning and Rome criteria, respectively, but only 11 and 3% of GPs and 40 and 60% of consultants had used these criteria. Thompson et al. [11] enrolled 36 GPs and reported that