‘Extremely low’ likelihood of missed GI diagnosis after using Rome IV criteria for IBS
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Key takeaways:
- One in six patients diagnosed with irritable bowel syndrome using Rome IV criteria were rereferred for examination.
- Only 1.1% of the entire cohort had a new gastrointestinal disease diagnosis.
A diagnosis of irritable bowel syndrome based on Rome IV criteria was “safe and durable,” with only 1% of patients diagnosed with a different gastrointestinal disease after rereferral and reinvestigation for ongoing IBS symptoms.
“National guidelines recommend a diagnosis of IBS is made using symptom-based criteria in combination with limited, judicious investigations,” Mais Khasawneh, MBBS, of the Leeds Gastroenterology Institute at St. James’s University Hospital, and colleagues wrote in Clinical Gastroenterology and Hepatology. “However, physicians find IBS challenging to diagnose because symptoms overlap with those of organic gastrointestinal conditions such as celiac disease, inflammatory bowel disease, microscopic colitis or bile acid diarrhea.”
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They continued: “This can result in diagnostic uncertainty on the part of both the doctor and the patient, particularly as symptoms are chronic and fluctuating, and treatments are not effective in all patients.”
Seeking to evaluate the durability of Rome IV criteria to diagnose IBS, Khasawneh and colleagues analyzed symptom data from 373 adults (mean age, 34.8 years; 76.7% women) who met Rome IV criteria for IBS and were referred for a standardized workup to exclude other disease between September 2016 and March 2020. During a mean follow-up of 4.2 years per patient, researchers assessed rates of rereferral, reinvestigation and missed GI disease diagnoses.
Results showed 62 patients received a rereferral, 35 for IBS and 27 for other GI symptoms. Of those rereferred for IBS, five patients had a change in symptoms, while the other 30 had comparable symptoms to baseline.
Twenty-one IBS patients were reinvestigated compared with 22 rereferred for other GI symptoms. Researchers identified only four new cases of relevant organic disease (9.3% of those reinvestigated and 1.1% of full cohort), which may have been responsible for baseline IBS symptoms.
“This study to assess durability of a diagnosis of Rome IV IBS, with patients managed as per national guidance, demonstrates that even though one in six patients were rereferred, either with ongoing IBS or other gastrointestinal symptoms, and more than two-thirds of those rereferred were reinvestigated, only 1% were diagnosed with an organic gastrointestinal disease subsequently,” Khasawneh and colleagues said.
They continued, “Physicians should be aware that using an approach of limited investigations combined with the application of recommended diagnostic criteria is a safe strategy for managing IBS in secondary care and that the yield of further investigation in a patient in whom IBS has already been diagnosed using this approach is extremely low.”
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