Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.
Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
Aliment Pharmacol Ther. 2015 Sep;42(5):491-503. doi: 10.1111/apt.13283. Epub 2015 Jun 15.
Irritable bowel syndrome (IBS) is a complex, heterogeneous disease which can be challenging to diagnose. No study has identified and assessed the accuracy of all available methods of diagnosing IBS.
To conduct a systematic review of the literature to identify and assess accuracy of symptom-based diagnostic criteria, biomarkers, psychological markers or combinations thereof.
MEDLINE, EMBASE and EMBASE Classic were searched (until April 2015) to identify studies reporting accuracy of available methods to diagnose IBS in adult populations. Eligible studies assessed accuracy of these diagnostic tests against an accepted reference standard. Data were extracted to calculate positive and negative likelihood ratios, with 95% confidence intervals (CIs), of the diagnostic test utilised. Where more than one study used the same test, data were pooled in a meta-analysis.
Twenty-two studies (7106 patients) were eligible. Positive and negative likelihood ratios of the current gold standard, the Rome III criteria, were 3.35 (95% CI: 2.97-3.79) and 0.39 (95% CI: 0.34-0.46), similar to other symptom-based criteria. Eleven biomarkers performed no better than symptom-based criteria. Psychological markers performed well in one study. Five different combinations were assessed. The best in terms of positive likelihood ratio was faecal calprotectin, intestinal permeability and Rome I criteria (26.4; 95% CI: 11.4-61.9), and in terms of negative likelihood ratio serum-based biomarkers and psychological markers (0.18; 95% CI: 0.12-0.25).
Symptom-based diagnostic criteria, biomarkers and psychological markers performed modestly in predicting IBS. Combining symptoms with markers appears more effective, and may represent the way forward in the diagnosis of IBS.
肠易激综合征（IBS）是一种复杂的、异质的疾病，诊断起来具有挑战性。目前还没有研究能够确定并评估所有现有的 IBS 诊断方法的准确性。
对文献进行系统综述，以确定和评估基于症状的诊断标准、生物标志物、心理标志物或其组合的准确性。
检索 MEDLINE、EMBASE 和 EMBASE Classic（截至 2015 年 4 月），以确定报告成人人群中可用方法诊断 IBS 的准确性的研究。合格的研究评估了这些诊断测试相对于公认的参考标准的准确性。提取数据以计算诊断测试的阳性和阴性似然比，置信区间（CI）为 95%。如果有多个研究使用相同的测试，则将数据合并进行荟萃分析。
有 22 项研究（7106 名患者）符合条件。当前金标准 Rome III 标准的阳性和阴性似然比分别为 3.35（95%CI：2.97-3.79）和 0.39（95%CI：0.34-0.46），与其他基于症状的标准相似。11 种生物标志物的表现并不优于基于症状的标准。在一项研究中，心理标志物表现良好。评估了五种不同的组合。就阳性似然比而言，最好的是粪便钙卫蛋白、肠道通透性和 Rome I 标准（26.4；95%CI：11.4-61.9），而就阴性似然比而言，最好的是血清生物标志物和心理标志物（0.18；95%CI：0.12-0.25）。
基于症状的诊断标准、生物标志物和心理标志物在预测 IBS 方面表现中等。将症状与标志物结合起来可能更有效，这可能是 IBS 诊断的未来方向。
