A DIAGNOSTIC SCORE FOR THE IRRITABLE BOWEL SYNDROME - ITS VALUE IN THE EXCLUSION OF ORGANIC-DISEASE

Abstract

Irritable bowel syndrome [IBS] is a very common clinical problem for which there are no established diagnostic criteria. The 2 aims of the present study were first to create a scoring system for the diagnosis of IBS incorporating features from the case history, physical examination and some basic investigations including erythrocyte sedimentation rate and blood count; and 2nd , to estimate the diagnostic accuracy of this scoring system in terms of its sensitivity and specificity, and of its predictive value in patients diagnosed as having IBS by conventional methods. A group of 479 consecutive outpatients referred to a gastrointestinal clinic was studied by the usual extensive routine workup practiced at the clinic, including numerous laboratory tests, endoscopy of upper and lower gastrointestinal tract and ultrasound. In 209 patients, symptoms were related to an underlying organic disease and in 108 patients IBS was diagnosed without any recognizable organic disease. As a separate exercise, a scoring system including the answers of a questionnaire and the results of 8 basic investigations was established. After completion of the study, the score was weighted by means of a logistic regression analysis. Using the weighted score, at a sensitivity of 64%, the specificity for the diagnosis of IBS was 99% and at a sensitivity of 83%, the specificity was 97%. Patients with organic diseases such as malignant tumor or inflammatory bowel disease were well discriminated by the score. A detailed history, physical examination, and basic laboratory tests are sufficient in most patients for the positive diagnosis of IBS and the exclusion of any underlying organic diseases.