The Role of Diagnostic Testing in Irritable Bowel Syndrome

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Diagnosis of IBS

The Rome Committee on Functional Gastrointestinal Disorders and other IBS authorities recommend that selected diagnostic tests be performed as part of the routine evaluation of patients with suspected IBS.15, 16 These tests include serum and stool studies, as well as colonic visualization, to exclude important organic gastrointestinal diseases.17 Others propose a limited screen for disorders that may masquerade as IBS, such as celiac disease.18 Recently the necessity of these evaluations has

Yield of diagnostic testing in patients with suspected IBS

The first systematic review of the English language medical literature regarding commonly used diagnostic tests for IBS was performed in conjunction with the ACG IBS Task Force statement in 2002.19 This review included clinical trials that were published between 1980 and 2001, in which patients who fulfilled symptom-based criteria for IBS underwent diagnostic testing. After applying established criteria for the quality and validity of trials,24, 25 6 studies fulfilled inclusion criteria.26, 27,

Summary

The optimal diagnostic approach to IBS continues to evolve. Although there is no completely reliable biomarker that can objectively differentiate IBS from organic disease, the available evidence would support the application of validated symptom-based clinical criteria along with a judicious use of selected laboratory and endoscopic testing. In that sense, the diagnosis of IBS remains a diagnosis of exclusion. In a primary care setting or initial clinical encounter with a patient without

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References (66)

  • M.N. Marsh

    Gluten, major histocompatibility complex, and the small intestine: a molecular and immunobiologic approach to the spectrum of gluten sensitivity

    Gastroenterology

    (1992)
  • B.M. Spiegel et al.

    Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis

    Gastroenterology

    (2004)
  • N.J. Talley et al.

    Medical costs in community subjects with irritable bowel syndrome

    Gastroenterology

    (1995)
  • D. Lieberman et al.

    Utilization of colonoscopy in the United States: results from a national consortium

    Gastrointest Endosc

    (2005)
  • L. Chang et al.

    Sensation of bloating and visible distension in patients with irritable bowel syndrome

    Am J Gastroenterol

    (2001)
  • Y. Ringel et al.

    Prevalence, characteristics, and impact of bloating symptoms in patients with irritable bowel syndrome

    Clin Gastroenterol Hepatol

    (2009)
  • M. Pimentel et al.

    Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a double-blind, randomized, placebo-controlled study

    Am J Gastroenterol

    (2003)
  • A.C. Ford et al.

    Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis

    Clin Gastroenterol Hepatol

    (2009)
  • P. Vernia et al.

    Lactose malabsorption, irritable bowel syndrome and self-reported milk intolerance

    Dig Liver Dis

    (2001)
  • D. Stark et al.

    Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and management

    Int J Parasitol

    (2007)
  • S.V. Kane et al.

    Fecal lactoferrin is a sensitive and specific marker in identifying intestinal inflammation

    Am J Gastroenterol

    (2003)
  • G.F. Longstreth et al.

    Irritable bowel-type symptoms in HMO examinees: prevalence, demographics and clinical correlates

    Dig Dis Sci

    (1993)
  • B.E. Lacy et al.

    Physicians’ attitudes and practices in the evaluation and treatment of irritable bowel syndrome

    Scand J Gastroenterol

    (2006)
  • B.M. Spiegel et al.

    Is irritable bowel syndrome a diagnosis of exclusion? A survey of primary care providers, gastroenterologists and IBS experts

    Am J Gastroenterol

    (2010)
  • A.P. Manning et al.

    Towards a positive diagnosis of the irritable bowel syndrome

    Br Med J

    (1978)
  • W.G. Thompson et al.

    Irritable bowel syndrome: guidelines for the diagnosis

    Gastroenterol Int

    (1989)
  • W.G. Thompson et al.

    Functional bowel disorders and functional abdominal pain

    Gut

    (1999)
  • L.J. Brandt et al.

    An evidence based approach to the diagnosis of irritable bowel syndrome in North America

    Am J Gastroenterol

    (2002)
  • W.E. Whitehead et al.

    Validation of symptom-based diagnostic criteria for IBS: a critical review

    Am J Gastroenterol

    (2010)
  • D.A. Drossman

    An integrated approach to the irritable bowel syndrome

    Aliment Pharmacol Ther

    (1999)
  • M. Camilleri et al.

    The irritable bowel syndrome: mechanisms and a practical approach to management

    Ann Intern Med

    (1992)
  • American Gastroenterological Association

    American Gastroenterological Association medical position statement: irritable bowel syndrome

    Gastroenterology

    (2002)
  • R.C. Spiller et al.

    Bowel disorders

    Am J Gastroenterol

    (2010)
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    The opinions and assertions contained herein are the sole views of the authors and should not be construed as official or as representing the views of the US Navy, Department of Defense, or Department of Veteran Affairs.

    Disclosure: Dr Cash has served as a consultant to Prometheus Laboratories.

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