Elsevier

Gastrointestinal Endoscopy

Volume 62, Issue 6, December 2005, Pages 892-899
Gastrointestinal Endoscopy

Original Article
Is a negative colonoscopy associated with reassurance or improved health-related quality of life in irritable bowel syndrome?

https://doi.org/10.1016/j.gie.2005.08.016Get rights and content

Background

Although colonoscopy is rarely of clinical use in irritable bowel syndrome (IBS), it is, nonetheless, frequently performed in IBS. Proponents contend that a normal colonoscopy provides reassurance and improves health-related quality of life (HRQOL). However, no previous data have measured these effects. We sought to measure the association of a normal colonoscopy with reassurance and HRQOL in patients with IBS aged <50 years.

Methods

We retrospectively evaluated 458 patients with IBS, aged 18 to 49 years. Subjects completed a symptom questionnaire, the Symptom Checklist 90 (SCL-90) psychometric checklist, and the Short Form 36 (SF-36) Health Survey. The main outcomes were HRQOL as measured by the mental component score (MCS) and the physical component score (PCS) of the SF-36 and reassurance as operationalized by a negative response to the question: “Do you think there is something seriously wrong with your body?” The independent variable was presence or absence of a previous normal colonoscopy. We performed regression analysis to control for potential confounders, including timing of colonoscopy.

Results

The unadjusted mean SF-36 PCS was 42 ± 10 (0-100 scale: 0, worst) in patients with recent colonoscopy (<12 months), 45 ± 11 in patients with distant colonoscopy (>12 months), and 45 ± 10 in patients without colonoscopy (p = 0.78). The mean SF-36 MCS in the 3 groups were 42 ± 13, 44 ± 11, and 43 ± 11 (p = 0.57). Colonoscopy did not impact the proportion reassured (69.3%, 67.2%, 66.6%; p = 0.85). There were no significant differences between groups for any outcomes when adjusting for potential confounders.

Conclusions

We found no independent association between a negative colonoscopy and reassurance or improved HRQOL in IBS patients aged <50 years. These results suggest that the role of colonoscopy in IBS may be limited but require confirmation in prospective trials.

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

References (35)

  • W.G. Thompson et al.

    Functional bowel disorders and functional abdominal pain

    Gut

    (1999)
  • American Gastroenterological Association Publication

    The burden of gastrointestinal diseases

    (2001)
  • D.A. Drossman et al.

    Householder survey of functional gastrointestinal disorders: prevalence, sociodemography and health impact

    Dig Dis Sci

    (1993)
  • B.P. Yawn et al.

    Diagnosis and care of irritable bowel syndrome in a community-based population

    Am J Manag Care

    (2001)
  • American College of Gastroenterology Functional Gastrointestinal Disorders Task Force

    Evidence-based position statement on the management of irritable bowel syndrome in North America

    Am J Gastroenterol

    (2002)
  • American Society for Gastrointestinal Endoscopy: Clinical Outcomes Research Initiative (CORI) Database Audit, 2001...
  • J.H. Svendsen et al.

    Irritable bowel syndrome: prognosis and diagnostic safety. A 5-year follow up study

    Scand J Gastroenterol

    (1985)
  • Cited by (76)

    • Diagnostic Yield of Colonoscopy in Patients With Symptoms Compatible With Rome IV Functional Bowel Disorders

      2022, Clinical Gastroenterology and Hepatology
      Citation 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 Hepatology
      Citation 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

      2020, The Lancet
    View all citing articles on Scopus

    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.

    View full text