Frequency of Abnormal Fecal Biomarkers in Irritable Bowel Syndrome

Abstract

Primary Study Objective:Determine the frequency of abnormal fecal biomarker test results in patients with 13 irritable bowel syndrome (IBS)–related ICD-9 (International Statistical Classification of Diseases and Related Health Problems) codes.Study Design:Quantitative review of de-identified records from patients in whom IBS was a possible diagnosis.Methods:Records were selected for analysis if they included any of 13 IBS-related diagnostic codes and laboratory test results of fecal testing for all biomarkers of interest. Data collection was restricted to one 12-month period. Frequency distributions were calculated to identify rates of abnormal results for each biomarker within the total number of tests conducted in the eligible population.Results:Two thousand, two hundred fifty-six records were included in the study, of which 1867 (82.8%) included at least one abnormal value. Quantitative stool culture for beneficial bacteria (Lactobacillus and Bifidobacterium) indicated low growth suggestive of intestinal dysbiosis in 73.1% of records, followed by abnormally elevated eosinophil protein X (suggestive of food allergy) in 14.3%, elevated calprotectin (suggestive of inflammation) in 12.1%, detection of parasites in 7.5%, and low pancreatic elastase (suggestive of exocrine pancreatic insufficiency) in 7.1%.Conclusions:Abnormal fecal biomarkers are prevalent in patients with diagnoses suggestive of IBS. Abnormal fecal biomarker testing, if confirmed in additional independent clinical trials, could substantially reduce the economic costs associated with diagnosis and management of IBS.

Validating biomarkers of treatable mechanisms in irritable bowel syndrome

“…To date, studies proposing the biomarkers have not been generally replicated or proven useful to guide treatment. For example, a recent study of 2256 medical records of patients with 13 IBS‐related diagnostic codes suggested that 82.8% of the patients had at least one abnormal fecal biomarker: quantitative stool culture for beneficial bacteria ( Lactobacillus and Bifidobacterium ) showed low growth (suggestive of intestinal dysbiosis) in 73.1%; abnormally elevated eosinophil protein X (suggestive of food allergy) in 14.3%; elevated calprotectin (suggestive of inflammation) in 12.1%; detection of parasites in 7.5%; and low pancreatic elastase (suggestive of exocrine pancreatic insufficiency) in 7.1% . These and other fecal biomarkers have been proposed for the differentiation of IBS from inflammatory bowel disease, although there clearly is overlap as exemplified by the 12.1% of patients with IBS codes who had elevated fecal calprotectin, and it has been suggested that, even in the primary care setting, the cutoff values of fecal calprotectin require revision to enhance the positive predictive value of the test for diagnosis …”

Diagnosis and management of pancreatic exocrine insufficiency

“…There are limited reliable data on the prevalence of PEI in the general population 5 . PEI often goes undetected and patients referred from primary care may not represent the majority of PEI sufferers within the community 3 , 4 , 17 , 18 …”

“…The symptoms of PEI are gastrointestinal‐related and non‐specific. If undiagnosed, patients may have ongoing symptoms such as diarrhoea and abdominal pain that can sometimes be mistaken as a functional bowel disorder 3 , 18 . PEI symptoms can vary from patient to patient, and are dependent on the degree of PEI experienced and its aetiology 5 …”

“…PEI is an underdiagnosed and often undertreated condition 3 , 5 , 18 , 38 . ‐ 41 The dilemma for the clinician, therefore, is to be able to determine which patients will benefit from further investigations and PEI treatment.…”

Does Irritable Bowel Syndrome Exist? Identifiable and Treatable Causes of Associated Symptoms Suggest It May Not

“…Notably, this particular study supported the hypothesis that "IBS-D and functional diarrhea are not true clinical entities as previously thought, but a collection of different, separate medical conditions." Similarly, another research group conducted a retrospective analysis of a biomarker test that identifies potentially treatable underlying causes of IBS in people that meet Rome III criteria and found that up to 94% have results suggesting a treatable underlying diagnosis or functional problem [18,19]. The same group also demonstrated that such testing significantly reduced medical and gastrointestinal procedural costs by improving patient care [20].…”