Source: Phlebology  |  Posted 9 years ago

Researchers in the United States say there is insufficient evidence to recommend routine use of standardised testing in patients who meet symptom-based criteria for irritable bowel syndrome (IBS).

"Among patients meeting symptom-based criteria for IBS, pre-test probability of inflammatory bowel disease, colorectal cancer or infectious diarrhoea is less than 1 percent," say the investigators led by Dr. Brooks Cash from the Uniformed Services University of Health Sciences in Bethesda, Maryland.

Their systematic review of the literature examined the most commonly used diagnostic tests ordered in patients with suspected IBS, including laboratory tests.

However, the researchers report the pre-test probability of celiac disease in such IBS patients is 10 times that found in the general population. While they suggest more research is needed in this area, they state: "Identification of celiac disease is quite attractive, given the availability of effective therapy and the ability of this therapy to prevent significant long-term morbidity."

Probability of identifying organic gastrointestinal disease responsible for IBS symptoms through colonic visualisation with flexible sigmoidoscopy, barium enema or colonoscopy is also less than 1 percent, the investigators say. Most identified colonic abnormalities are asymptomatic.

The literature also did not support rectal biopsies and abdominal imaging tests as routine for IBS patients meeting symptom-based criteria. Data was similarly lacking on standard laboratory tests for identifying inflammatory bowel, colorectal cancer and celiac disease.

The researchers point out diagnostic evaluation is indicated in patients with "alarm" symptoms: weight loss, gross haematochezia or systemic infection.