Original ArticleIs a negative colonoscopy associated with reassurance or improved health-related quality of life in irritable bowel syndrome?
Section snippets
Patients
We analyzed consecutive patients aged 18 to 49 years with Rome I or II positive IBS evaluated at the University of California at Los Angeles Center for Neurovisceral Sciences and Women's Health between January 1, 1995, and December 31, 2002. The Rome criteria provide a valid and reproducible definition of IBS and are the most stringent criteria for accurately diagnosing IBS (Table 1).1 The Center for Neurovisceral Sciences and Women's Health is a university-based specialty clinic that focuses
Patient characteristics
There were 458 patients with Rome-positive IBS who completed the study questionnaire. The mean age was 38 ± 13 years, and 72% of the cohort were women. Of the cohort, 78% were white and 8% were African American. Thirty-six percent of the patients had at least a high-school education, and 21% had attended college. By using the suggested criteria in the Rome II manual, 40% of the cohort had diarrhea-predominant IBS, 32% constipation-predominant IBS, and 28% alternating IBS (i.e., fit neither the
Discussion
This analysis found that a negative colonoscopy was not associated with a decreased belief in the serious nature of IBS symptoms or improved HRQOL in patients less than 50 years of age, despite accounting for potential confounders. Given that colonoscopy rarely advances the diagnosis of IBS in patients less than 50 years of age, colonoscopy may confuse the clinical picture with unrelated findings, may undermine an otherwise confident diagnosis, and is relatively expensive, and these results
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Cited by (76)
A Diagnosis of Irritable Bowel Syndrome Using Rome IV Criteria and Limited Investigations is Durable in Secondary Care
2023, Clinical Gastroenterology and HepatologyUp-Front Endoscopy Maximizes Cost-Effectiveness and Cost-Satisfaction in Uninvestigated Dyspepsia
2023, Clinical Gastroenterology and HepatologyDiagnostic Yield of Colonoscopy in Patients With Symptoms Compatible With Rome IV Functional Bowel Disorders
2022, Clinical Gastroenterology and HepatologyCitation Excerpt :Nevertheless, we show that a small fraction of patients with symptoms compatible with FBDs and no alarm features still undergo a colonoscopy despite the low diagnostic yield, and reasons for this may include ongoing patient concerns. However, a study in 458 patients found no independent association between a negative colonoscopy and reassurance or improved health-related quality in patients with IBS aged <50 years.22 Similarly, a positive diagnostic strategy in those without alarm feature is noninferior to a diagnosis of exclusion.23
The overlap between irritable bowel syndrome and organic gastrointestinal diseases
2021, The Lancet Gastroenterology and HepatologyCitation Excerpt :A colonoscopy might be seen as a measure to reassure the patient or even the health-care provider.86,87 However, a study in 458 patients found no independent association between a negative colonoscopy and reassurance or improved health-related quality in patients with IBS younger than 50 years.86 In the future, this type of clinical scenario would benefit from an alternate approach whereby having a simple diagnostic biomarker to identify IBS will help quash any potential uncertainties that might still exist and avoid unnecessary colonoscopy investigations.
Irritable bowel syndrome
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2020, The Lancet Gastroenterology and Hepatology
B.M.R. Spiegel is supported by a VA HSR&D Research Career Development Award. L. Chang is supported by NIH grants R01 AR46122-01 and P50 DK64539. B. Naliboff is supported by NIH grants R01 NINR DK-07768. I. M. Gralnek is supported by a VA HSR&D Advanced Research Career Development Award. G. S. Dulai is supported by NIH K23 Career Development Award RR-16188. E. A. Mayer is supported by NIH grants R01 DK-48351 and P50 DK-64539. B.M.R. Spiegel, E. A. Mayer, R. Bolus, L. Chang, I. M. Gralnek, and B. Naliboff are supported by NIH Center grant 1 R24 AT002681-NCCAM.