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Construction and validation of a questionnaire distinguishing a chronic abdominal wall pain syndrome from irritable bowel syndrome
  1. Tijmen van Assen1,
  2. Oliver B Boelens1,
  3. Jan T Kamphuis2,
  4. Marc R Scheltinga1,
  5. Rudi M Roumen1
  1. 1Department of Surgery, Máxima Medical Centre, Veldhoven, The Netherlands
  2. 2Department of Gastroenterology, Máxima Medical Centre, Veldhoven, The Netherlands
  1. Correspondence to Dr Tijmen van Assen, Department of Surgery, Máxima Medical Centre, Secr. Heelkunde, Antwoordnummer 10080, 5500 VB Veldhoven, The Netherlands; tijmenvanassen{at}


Objective The irritable bowel syndrome (IBS) population is heterogeneous, harbouring a variety of abdominal symptoms. Therefore, IBS is often termed a ‘diagnosis of exclusion’. Chronic abdominal wall pain (CAWP) is a poorly recognized entity, frequently caused by the anterior cutaneous nerve entrapment syndrome (ACNES). Some patients may be misdiagnosed because IBS and CAWP share symptoms. Aim of this study was to construct and validate a questionnaire to distinguish patients with CAWP (including ACNES) patients with IBS.

Design A questionnaire was designed of 17 ACNES characteristic items obtained from ACNES patients (n=33) and expert opinion of two specialized surgeons. Eleven IBS-related items (‘Rome III’ criteria) were added leading to a questionnaire containing 28 items. This was validated in a ‘gold standard’ ACNES group (successfully operated ACNES patients, n=68) and a ‘prospective’ IBS group (n=64) as well as in a ‘prospective’ ACNES group (n=47). Distinctive power of individual items was analyzed by χ2. Reliability was tested with Crohnbach's α. ROC curve was used to determine cut-off values.

Results Eighteen of 28 items were significantly distinctive (p<0.01) between ACNES and IBS patients leading to an 18-point ACNES score with good internal consistency (α=0.85). Cut-off value of 10 points resulted in 94% sensitivity, 92% specificity and areas under the curve (AUC) of 0.98. Evaluation of the prospective ACNES group led to 85% sensitivity, 92% specificity and AUC 0.95 indicating high discriminative properties of the questionnaire.

Conclusions This novel questionnaire may be useful and valid as a simple tool distinguishing patients harbouring a CAWP syndrome from those having IBS.

  • Abdominal Pain
  • Irritable Bowel Syndrome
  • Functional Bowel Disorder
  • Funactional Abdominal Pain

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  • Funding The study was funded by a grant from the Stichting Hart- en Vaatziekten Zuid Nederland.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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