Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
Gastroenterology. 2013 Dec;145(6):1262-70.e1. doi: 10.1053/j.gastro.2013.08.048. Epub 2013 Aug 28.
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.
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.
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).
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.
目前用于诊断肠易激综合征（IBS）的标准较少，本研究旨在对罗马标准和曼宁标准进行验证。
在安大略省汉密尔顿的 2 家医院中，我们对 1848 例成年胃肠道症状患者进行了前瞻性队列研究，采集了完整的症状、结肠镜检查和组织学数据；研究者对症状状态进行了盲法评估。对于结肠镜和组织学检查正常、无乳糜泻证据且无器质性胃肠道疾病的患者，我们将其归为无器质性胃肠道疾病。采用下腹痛或不适与排便习惯改变并存且无器质性胃肠道疾病的方法作为定义真正 IBS 的参考标准。我们计算了各诊断标准的敏感性、特异性、阳性似然比和阴性似然比及其 95%置信区间。
在识别 IBS 患者时，各标准的敏感性范围为 61.9%（曼宁标准）至 95.8%（罗马标准 I），特异性范围为 70.6%（罗马标准 I）至 81.8%（曼宁标准）。阳性似然比范围为 3.19（罗马标准 II）至 3.39（曼宁标准），阴性似然比范围为 0.06（罗马标准 I）至 0.47（曼宁标准）。罗马标准 I 与罗马标准 II 之间的诊断标准一致性最高（κ=0.95），而曼宁标准与罗马标准 III 之间的一致性最低（κ=0.59）。
目前的诊断标准在区分 IBS 与器质性疾病方面的性能一般。在准确性方面似乎没有太大差异。需要寻找更准确的方法来诊断 IBS，以避免不必要的检查。
