Tags

Type your tag names separated by a space and hit enter

Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome.
Aliment Pharmacol Ther 2006; 24(1):137-46AP

Abstract

BACKGROUND

Studies suggest that the positive predictive value of the Rome II criteria for diagnosing irritable bowel syndrome can be enhanced by excluding red flag symptoms suggestive of organic diseases.

AIM

We assessed the utility of red flags for detecting organic diseases in patients diagnosed irritable bowel syndrome by their physicians.

METHODS

Systematic chart reviews were completed in 1434 patients with clinical diagnoses of irritable bowel syndrome, abdominal pain, diarrhoea or constipation, who also completed questionnaires to identify Rome II criteria for irritable bowel syndrome and red flag symptoms.

RESULTS

The overall incidence of gastrointestinal cancer was 2.5% (but 1.0% in those with irritable bowel syndrome), for inflammatory bowel disease 2.0% (1.2% in irritable bowel syndrome), and for malabsorption 1.3% (0.7% in irritable bowel syndrome). Red flags were reported by 84% of the sample. The positive predictive value of individual red flags for identifying organic disease was 7-9%. Excluding any patient with a red flag improved the agreement between Rome II and clinical diagnosis by a modest 5%, but left 84% of patients who were diagnosed with irritable bowel syndrome by their physicians, without a diagnosis.

CONCLUSIONS

Red flags may be useful for identifying patients who require additional diagnostic evaluation, but incorporating them into the Rome criteria would not improve sensitivity and would result in too many missed irritable bowel syndrome diagnoses.

Authors+Show Affiliations

Center for Functional GI and Motility Disorders, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. william_whitehead@med.unc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16803612

Citation

Whitehead, W E., et al. "Utility of Red Flag Symptom Exclusions in the Diagnosis of Irritable Bowel Syndrome." Alimentary Pharmacology & Therapeutics, vol. 24, no. 1, 2006, pp. 137-46.
Whitehead WE, Palsson OS, Feld AD, et al. Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome. Aliment Pharmacol Ther. 2006;24(1):137-46.
Whitehead, W. E., Palsson, O. S., Feld, A. D., Levy, R. L., VON Korff, M., Turner, M. J., & Drossman, D. A. (2006). Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 24(1), pp. 137-46.
Whitehead WE, et al. Utility of Red Flag Symptom Exclusions in the Diagnosis of Irritable Bowel Syndrome. Aliment Pharmacol Ther. 2006 Jul 1;24(1):137-46. PubMed PMID: 16803612.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome. AU - Whitehead,W E, AU - Palsson,O S, AU - Feld,A D, AU - Levy,R L, AU - VON Korff,M, AU - Turner,M J, AU - Drossman,D A, PY - 2006/6/29/pubmed PY - 2007/1/19/medline PY - 2006/6/29/entrez SP - 137 EP - 46 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 24 IS - 1 N2 - BACKGROUND: Studies suggest that the positive predictive value of the Rome II criteria for diagnosing irritable bowel syndrome can be enhanced by excluding red flag symptoms suggestive of organic diseases. AIM: We assessed the utility of red flags for detecting organic diseases in patients diagnosed irritable bowel syndrome by their physicians. METHODS: Systematic chart reviews were completed in 1434 patients with clinical diagnoses of irritable bowel syndrome, abdominal pain, diarrhoea or constipation, who also completed questionnaires to identify Rome II criteria for irritable bowel syndrome and red flag symptoms. RESULTS: The overall incidence of gastrointestinal cancer was 2.5% (but 1.0% in those with irritable bowel syndrome), for inflammatory bowel disease 2.0% (1.2% in irritable bowel syndrome), and for malabsorption 1.3% (0.7% in irritable bowel syndrome). Red flags were reported by 84% of the sample. The positive predictive value of individual red flags for identifying organic disease was 7-9%. Excluding any patient with a red flag improved the agreement between Rome II and clinical diagnosis by a modest 5%, but left 84% of patients who were diagnosed with irritable bowel syndrome by their physicians, without a diagnosis. CONCLUSIONS: Red flags may be useful for identifying patients who require additional diagnostic evaluation, but incorporating them into the Rome criteria would not improve sensitivity and would result in too many missed irritable bowel syndrome diagnoses. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/16803612/Utility_of_red_flag_symptom_exclusions_in_the_diagnosis_of_irritable_bowel_syndrome_ L2 - https://doi.org/10.1111/j.1365-2036.2006.02956.x DB - PRIME DP - Unbound Medicine ER -