title: Prevalence of organic disease at colonoscopy in patients with symptoms compatible with irritable bowel syndrome: cross-sectional survey.
abstract: OBJECTIVE
  Guidelines for the management of irritable bowel syndrome (IBS) encourage a positive diagnosis, but some evidence suggests organic disease may be missed unless investigations are performed. We examined yield of colonoscopy in a cohort of secondary care patients meeting criteria for IBS.
  
  
  METHODS
  Demographic data, symptoms and findings at colonoscopy were recorded prospectively in consecutive, unselected adults with gastrointestinal (GI) symptoms compatible with IBS according to the Rome III criteria. Prevalence of organic GI disease was compared between those meeting criteria for IBS, according to the presence or absence of co-existent alarm features, and by IBS subtype.
  
  
  RESULTS
  A total of 559 patients met Rome III criteria for IBS, of whom 423 reported ≥1 alarm feature and 136 none. There was a significantly higher prevalence of organic GI disease among those reporting alarm features (117 [27.7%]), compared with those without (21 [15.4%]) (p = 0.002). In the latter group of 136 patients, Crohn's disease was the commonest finding (10 [7.4%] subjects), followed by coeliac disease (4 [2.9%] subjects), and microscopic colitis (3 [2.2%] subjects). Regardless of presence or absence of alarm features, patients with constipation-predominant IBS were less likely to exhibit organic GI disease than those with diarrhea-predominant or mixed IBS (12.7% vs. 32.1% and 23.8%, p = 0.006).
  
  
  CONCLUSIONS
  One in six patients with symptoms compatible with IBS without alarm features in this selected group exhibited organic GI disease following investigation. Assessment of alarm features in a comprehensive history is vital to reduce diagnostic uncertainty that can surround IBS.
authors: Leeds Gastroenterology Institute, St. James's University Hospital , Leeds , UK.
authors: Purav
authors: P
authors: Patel
authors: Premysl
authors: P
authors: Bercik
authors: David G
authors: DG
authors: Morgan
authors: Carolina
authors: C
authors: Bolino
authors: Maria Ines
authors: MI
authors: Pintos-Sanchez
authors: Paul
authors: P
authors: Moayyedi
authors: Alexander C
authors: AC
authors: Ford
mesh_terms: D015746:Abdominal Pain; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003113:Colonoscopy / Q000379:methods*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D003967:Diarrhea; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
keywords: abdominal pain; hard stools; loose stools; straining