Irritable bowel syndrome
Measured Factor Detail
The Kruis Score helps to differentiate IBS from organic bowel disease | It uses symptoms and lab testing to suggest which patients likely have IBS
Measured Factor Low Impact
- If score is < 44, the test is negative for IBS
- If any “red flags” are their, consider further assessment for other pathology.
Measured Factor High Impact
- If score >44, positive for IBS.
Result Low Conditions
- abdominal pain
- bowel irregularity
Symptom-based criteria for diagnosis of IBS has unclear ovarall accuracy, need to improvement for specificity and sensitivity.
Study Validation 1
Review of validation of diagnostic criteria based on symptoms for irritable bowel syndrome (IBS). There are two different kinds of validations reported: study testing patients with and without structural disease at colonoscopy discriminate by symptom criteria; study testing discrimination by symptom criteria to patients have IBS from positive diagnosis from healthy persons or patients having other structural and functional disorders. IBS is explained only with structural disease exclusion so the first study addresses that it can't provide positive predictive value or sensitivity. The second study validates the performance of the symptom criteria as predicted by its theory. Sensitivity, 0.4 to 0.9 by symptom-based criteria with clinical diagnosis. Patients with IBS who fulfill Rome II criteria have the poor quality of life as compared to patients who don't fulfill Rome II criteria. In addition, Rome I, Rome II, and Manning criteria have same specificity and sensitivity.
Study Validation 2
Manning et al. explained that some symptoms distinguished between irritable bowel syndrome (IBS) and organic gastrointestinal disease (OGD). Which were abdominal distention, incomplete evacuation feeling, and pain with frequent stools. Kruis et al. explained other simple scoring system to distinguished IBS and OGD. A study was conducted to check the validity of Kruis scoring system and Manning's criteria when used combined and apart. The study based on 347 patients; 165 patients had IBS and 182 patients had OGD. 90% sensitivity and 87% specificity evaluated to distinguished both diseases with Manning's criteria, Kruis scoring system evaluated 81% sensitivity and 91% specificity by distinguishing IBS and OGD. Combined system evaluated 80% sensitivity and 97% specificity. In addition, both systems had strong co-relation by comparing IBS.
Study Validation 3
An outpatient study was conducted to validate Kruis scoring system in the gastrointestinal clinic with various lab tests including upper and lower gastrointestinal tract endoscopy, and ultrasound. 209 patients underlying with symptoms organic disease and 108 patients with irritable bowel syndrome (IBS) without any organic disease. The study evaluated with 64% sensitivity and 99% specificity for the diagnosis of IBD and specificity was 97% at 83% sensitivity. In addition, scoring system well distinguished between organic diseases by physical exam, basic lab test, and detailed history.
Study Additional 1
A systemic review was conducted from twenty two studies on 7106 patients for the accuracy of irritable bowel syndrome (IBS) diagnostic criteria. Confidence intervals (CIs) of Roma III criteria were 95%, 3.35 (2.97 to 3.79) and 95%, 0.39 (0.34 to 0.46). 95% CIs 26.4 (11.4 to 61.9) of intestinal permeability, faecal calprotectin and Roma I criteria. In addition, symptom-based criteria, psychological markers and biomarkers performed in predicting IBS.
Study Additional 2
A study was conducted to check the effect of probiotic Escherichia coli Nissle 1917 (EcN) for irritable bowel syndrome (IBS). Total 120 patients were included for the double-blind study based on the Roma III criteria. 60 patients were administered with placebo and 60 with EcN for 12 weeks. After 10 and 11 weeks, there were significant differences that EcN group had 20% points with 95% CI 2.6; 37.4, p = 0.01 and placebo group had 18.3 points with 95% CI 1.0; 35.7, p = 0.02. In addition, probiotic showed effects in irritable bowel syndrome.