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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Predictive value of alarm symptoms in Rome IV irritable bowel syndrome: A multicenter cross-sectional study
Qian Yang, Zhong-Cao Wei, Na Liu, Yang-Lin Pan, Xiao-Sa Jiang, Xin-Xing Tantai, Qi Yang, Juan Yang, Jing-Jie Wang, Lei Shang, Qiang Lin, Cai-Lan Xiao, Jin-Hai Wang
Qian Yang, Zhong-Cao Wei, Na Liu, Xiao-Sa Jiang, Xin-Xing Tantai, Cai-Lan Xiao, Jin-Hai Wang, Department of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Yang-Lin Pan, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi’an 710032, Shaanxi Province, China
Qi Yang, Juan Yang, Department of Gastroenterology, Xi’an No. 3 Hospital, The Affiliated Hospital of Northwest University, Xi’an 710018, Shaanxi Province, China
Jing-Jie Wang, Qiang Lin, Department of Gastroenterology, Tangdu Hospital, Air Force Medical University, Xi’an 710038, Shaanxi Province, China
Lei Shang, Department of Health Statistics, Air Force Medical University, Xi’an 710032, Shaanxi Province, China
Author contributions: Yang Q, Wang JH and Liu N concepted and designed the study; Yang Q, Wei ZC, Yang Q, Yang J, Wang JJ, Lin Q, Jiang XS and Xiao CL responsible for the acquisition of the data; Yang Q, Wei ZC, Shang L and Tantai XX involved in analysis and interpretation of data; Yang Q, Wang JH, Pan YL and Liu N drafted the manuscript and revised the article critically for important intellectual content; all authors have read and approved the final version of manuscript.
Supported by the Key Research and Development Program of Shaanxi Province, No. 2017ZDXM-SF-046.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Second Affiliated Hospital of Xi'an Jiaotong University.
Informed consent statement: The patient's personal information will be treated in a cryptic manner and given a code that distinguishes it from other individuals to mark the patient. No personal information will be disclosed in any report or publication related to the study, and therefore no harm will be caused to the patient mentally or physically. In view of the above, we apply for exemption of subject's informed consent.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jin-hai Wang, MD, Professor, Department of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, No. 157 Xiwu Road, Xi’an 710004, Shaanxi Province, China. jinhaiwang@hotmail.com
Received: July 31, 2021
Peer-review started: July 31, 2021
First decision: October 22, 2021
Revised: November 8, 2021
Accepted: December 10, 2021
Article in press: December 10, 2021
Published online: January 14, 2022
BACKGROUND
Irritable bowel syndrome (IBS) is a common functional bowel disease that shares features with many organic diseases and cannot be accurately diagnosed by symptom-based criteria. Alarm symptoms have long been applied in the clinical diagnosis of IBS. However, no study has explored the predictive value of alarm symptoms in suspected IBS patients based on the latest Rome IV criteria.
AIM
To investigate the predictive value of alarm symptoms in suspected IBS patients based on the Rome IV criteria.
METHODS
In this multicenter cross-sectional study, we collected data from 730 suspected IBS patients evaluated at 3 tertiary care centers from August 2018 to August 2019. Patients with IBS-like symptoms who completed colonoscopy during the study period were initially identified by investigators through medical records. Eligible patients completed questionnaires, underwent laboratory tests, and were assigned to the IBS or organic disease group according to colonoscopy findings and pathology results (if a biopsy was taken). Independent risk factors for organic disease were explored by logistic regression analysis, and the positive predictive value (PPV) and missed diagnosis rate were calculated.
RESULTS
The incidence of alarm symptoms in suspected IBS patients was 75.34%. Anemia [odds ratio (OR) = 2.825, 95% confidence interval (CI): 1.273-6.267, P = 0.011], fecal occult blood [OR = 1.940 (95%CI: 1.041-3.613), P = 0.037], unintended weight loss (P = 0.009), female sex [OR = 0.560 (95%CI: 0.330-0.949), P = 0.031] and marital status (P = 0.030) were independently correlated with organic disease. The prevalence of organic disease was 10.41% in suspected IBS patients. The PPV of alarm symptoms for organic disease was highest for anemia (22.92%), fecal occult blood (19.35%) and unintended weight loss (16.48%), and it was 100% when these three factors were combined. The PPV and missed diagnosis rate for diagnosing IBS were 91.67% and 74.77% when all alarm symptoms were combined with Rome IV and 92.09% and 34.10% when only fecal occult blood, unintended weight loss and anemia were combined with Rome IV, respectively.
CONCLUSION
Anemia, fecal occult blood and unintended weight loss have high predictive value for organic disease in suspected IBS patients and can help identify patients requiring further examination but are not recommended as exclusion criteria for IBS.
Core Tip: The diagnosis of irritable bowel syndrome (IBS) depends on symptom-based criteria, but the accuracy of these criteria is poor. For suspected IBS patients meeting the Rome IV criteria, considering alarm symptoms does not significantly improve the positive predictive value for diagnosing IBS. However, alarm symptoms can help identify patients with organic disease; in particular, fecal occult blood, unintended weight loss and anemia have a high predictive value for organic disease. The presence of those alarm symptoms suggests that further examination may be needed, but they are not recommended as exclusion criteria for IBS.
