Yang Qian, Wei Zhong-Cao, Liu Na, Pan Yang-Lin, Jiang Xiao-Sa, Tantai Xin-Xing, Yang Qi, Yang Juan, Wang Jing-Jie, Shang Lei, Lin Qiang, Xiao Cai-Lan, Wang Jin-Hai
Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China.
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.
World J Clin Cases. 2022 Jan 14;10(2):563-575. doi: 10.12998/wjcc.v10.i2.563.
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.
To investigate the predictive value of alarm symptoms in suspected IBS patients based on the Rome IV criteria.
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.
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, = 0.011], fecal occult blood [OR = 1.940 (95%CI: 1.041-3.613), = 0.037], unintended weight loss ( = 0.009), female sex [OR = 0.560 (95%CI: 0.330-0.949), = 0.031] and marital status ( = 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.
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.
肠易激综合征（IBS）是一种常见的功能性肠病，与许多器质性疾病有共同特征，无法通过基于症状的标准准确诊断。警示症状长期以来一直应用于IBS的临床诊断。然而，尚无研究基于最新的罗马IV标准探讨警示症状在疑似IBS患者中的预测价值。
基于罗马IV标准研究警示症状在疑似IBS患者中的预测价值。
在这项多中心横断面研究中，我们收集了2018年8月至2019年8月在3家三级医疗中心评估的730例疑似IBS患者的数据。研究期间完成结肠镜检查的有IBS样症状的患者最初由研究者通过病历识别。符合条件的患者完成问卷、接受实验室检查，并根据结肠镜检查结果和病理结果（如果进行了活检）被分配到IBS或器质性疾病组。通过逻辑回归分析探索器质性疾病的独立危险因素，并计算阳性预测值（PPV）和漏诊率。
疑似IBS患者中警示症状的发生率为75.34%。贫血[比值比（OR）=2.825，95%置信区间（CI）：1.273 - 6.267，P = 0.011]、粪便潜血[OR = 1.940（95%CI：1.041 - 3.613），P = 0.037]、非故意体重减轻（P = 0.009）、女性[OR = 0.560（95%CI：0.330 - 0.949），P = 0.031]和婚姻状况（P = 0.030）与器质性疾病独立相关。疑似IBS患者中器质性疾病的患病率为10.41%。贫血（22.92%）、粪便潜血（19.35%）和非故意体重减轻（16.48%）的警示症状对器质性疾病的PPV最高，当这三个因素联合时为100%。当所有警示症状与罗马IV标准联合时，诊断IBS的PPV和漏诊率分别为91.67%和74.77%，当仅粪便潜血、非故意体重减轻和贫血与罗马IV标准联合时，分别为92.09%和34.10%。
贫血、粪便潜血和非故意体重减轻对疑似IBS患者的器质性疾病具有较高的预测价值，有助于识别需要进一步检查的患者，但不建议作为IBS的排除标准。
