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Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care.
Gastroenterology. 2013 Dec; 145(6):1262-70.e1.G

Abstract

BACKGROUND & AIMS

There are few validation studies of existing diagnostic criteria for irritable bowel syndrome (IBS). We conducted a validation study of the Rome and Manning criteria in secondary care.

METHODS

We collected complete symptom, colonoscopy, and histology data from 1848 consecutive adult patients with gastrointestinal symptoms at 2 hospitals in Hamilton, Ontario; the subjects then underwent colonoscopy. Assessors were blinded to symptom status. Individuals with normal colonoscopy and histopathology results, and no evidence of celiac disease, were classified as having no organic gastrointestinal disease. The reference standard used to define the presence of true IBS was lower abdominal pain or discomfort in association with a change in bowel habit and no organic gastrointestinal disease. Sensitivity, specificity, and positive and negative likelihood ratios, with 95% confidence intervals, were calculated for each diagnostic criteria.

RESULTS

In identifying patients with IBS, sensitivities of the criteria ranged from 61.9% (Manning) to 95.8% (Rome I), and specificities from 70.6% (Rome I) to 81.8% (Manning). Positive likelihood ratios ranged from 3.19 (Rome II) to 3.39 (Manning), and negative likelihood ratios from 0.06 (Rome I) to 0.47 (Manning). The level of agreement between diagnostic criteria was greatest for Rome I and Rome II (κ = 0.95), and lowest for Manning and Rome III (κ = 0.59).

CONCLUSIONS

Existing diagnostic criteria perform modestly in distinguishing IBS from organic disease. There appears to be little difference in terms of accuracy. More accurate ways of diagnosing IBS, avoiding the need for investigation, are required.

Authors+Show Affiliations

Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. Electronic address: alexf12399@yahoo.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

23994201

Citation

Ford, Alexander C., et al. "Validation of the Rome III Criteria for the Diagnosis of Irritable Bowel Syndrome in Secondary Care." Gastroenterology, vol. 145, no. 6, 2013, pp. 1262-70.e1.
Ford AC, Bercik P, Morgan DG, et al. Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gastroenterology. 2013;145(6):1262-70.e1.
Ford, A. C., Bercik, P., Morgan, D. G., Bolino, C., Pintos-Sanchez, M. I., & Moayyedi, P. (2013). Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gastroenterology, 145(6), 1262-e1. https://doi.org/10.1053/j.gastro.2013.08.048
Ford AC, et al. Validation of the Rome III Criteria for the Diagnosis of Irritable Bowel Syndrome in Secondary Care. Gastroenterology. 2013;145(6):1262-70.e1. PubMed PMID: 23994201.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. AU - Ford,Alexander C, AU - Bercik,Premysl, AU - Morgan,David G, AU - Bolino,Carolina, AU - Pintos-Sanchez,Maria Ines, AU - Moayyedi,Paul, Y1 - 2013/08/28/ PY - 2013/06/21/received PY - 2013/08/08/revised PY - 2013/08/20/accepted PY - 2013/9/3/entrez PY - 2013/9/3/pubmed PY - 2014/2/25/medline KW - Accuracy KW - BMI KW - CI KW - GI KW - IBS KW - Irritable Bowel Syndrome KW - LR KW - Rome III Criteria KW - Sensitivity KW - Specificity KW - body mass index KW - confidence interval KW - gastrointestinal KW - irritable bowel syndrome KW - likelihood ratio SP - 1262 EP - 70.e1 JF - Gastroenterology JO - Gastroenterology VL - 145 IS - 6 N2 - BACKGROUND & AIMS: There are few validation studies of existing diagnostic criteria for irritable bowel syndrome (IBS). We conducted a validation study of the Rome and Manning criteria in secondary care. METHODS: We collected complete symptom, colonoscopy, and histology data from 1848 consecutive adult patients with gastrointestinal symptoms at 2 hospitals in Hamilton, Ontario; the subjects then underwent colonoscopy. Assessors were blinded to symptom status. Individuals with normal colonoscopy and histopathology results, and no evidence of celiac disease, were classified as having no organic gastrointestinal disease. The reference standard used to define the presence of true IBS was lower abdominal pain or discomfort in association with a change in bowel habit and no organic gastrointestinal disease. Sensitivity, specificity, and positive and negative likelihood ratios, with 95% confidence intervals, were calculated for each diagnostic criteria. RESULTS: In identifying patients with IBS, sensitivities of the criteria ranged from 61.9% (Manning) to 95.8% (Rome I), and specificities from 70.6% (Rome I) to 81.8% (Manning). Positive likelihood ratios ranged from 3.19 (Rome II) to 3.39 (Manning), and negative likelihood ratios from 0.06 (Rome I) to 0.47 (Manning). The level of agreement between diagnostic criteria was greatest for Rome I and Rome II (κ = 0.95), and lowest for Manning and Rome III (κ = 0.59). CONCLUSIONS: Existing diagnostic criteria perform modestly in distinguishing IBS from organic disease. There appears to be little difference in terms of accuracy. More accurate ways of diagnosing IBS, avoiding the need for investigation, are required. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/23994201/Validation_of_the_Rome_III_criteria_for_the_diagnosis_of_irritable_bowel_syndrome_in_secondary_care_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(13)01268-7 DB - PRIME DP - Unbound Medicine ER -