Prevalence of Organic Colonic Lesions by Colonoscopy in Patients Fulfilling ROME IV Criteria of Irritable Bowel Syndrome

Abstract

Introduction: Irritable bowel syndrome occurs as recurrent abdominal pain that is related to defecation and associated with change in frequency and/or form of stool. Few Patients with IBS may have organic lesions detectable at colonoscopy.
 Methods: A cross sectional study was carried out in 140 consecutive patients of IBS fulfilling the ROME IV criteria. The study was conducted in Gastroenterology unit, Department of Medicine, Bir hospital, Kathmandu from July 2016 to September 2017. All patients underwent full colonoscopy along with biopsy from sigmoid colon and any visibly abnormal areas.
 Results: The average age of patients was 37.5 years with 76 (52.8%) males. Forty-two (30%) had IBS-D, 36 (26%) had IBS-C, 31 (22%) had IBS-M and 31 (22%) had IBS-U. Dyspepsia was seen in 16 (11.4%) and fear of TB/Malignancy/IBD was seen in 27 (19.2%). Organic lesions were seen in 39 (27.85%) patients. Nonspecific colitis was seen in 10 (7.1%) followed by ileal erosions in 7 (5%), polyps in 8 (5.7%), hemorrhoids in 6 (4.2%) and diverticula in 3 (2.1%). Only one (0.71%) patient had microscopic colitis and one (0.71%) had malignant lesion seen at histopathological examination. Females with IBS-D had more organic findings than males (P=0.03, RR=4.13, 95% CI=1.21-15.71).
 Conclusions: The prevalence of organic lesions in patients with IBS fulfilling ROME IV criteria is 27%. Dyspepsia is the most common comorbidity and fear of TB/malignancy/IBD is the most common reason for seeking health care. Females with IBS-D have a higher risk of detecting organic lesions by colonoscopy and histopathology examination.

Systematic Review and Meta-Analysis: What is the Prevalence of Non-Malignant, Organic Gastrointestinal Disorders Misdiagnosed as Lrritable Bowel Syndrome?

“…Also, patients with constipation predominant IBS were included in some of these studies. Two of the studies we included only examined biopsies from the left side of colon [45,65] which may also underestimate prevalence rates. Our calculated crude pooled rate may also underestimate PEI as Leeds et al used a faecal elastase-1 cut-off of < 100 µg/g, re ecting only the presence of severe PEI [66].…”

“…There was signi cant heterogeneity in effect sizes (Q-test X 2 = 115•8, P < 0•0001; I 2 = 86•2%). Three studies [44][45][46] were deemed to be of high risk of bias and after excluding them a repeat analysis estimated the prevalence of MC to be 4% (95% CI 2-5%), and the level of heterogeneity between studies remained unchanged (Q-test X 2 = 107•0, P < 0•0001; I 2 = 87•9%, Supplementary Fig. 19).…”

Diagnostic Yield of Colonoscopy in Patients With Symptoms Compatible With Rome IV Functional Bowel Disorders

“…Adhering to such guidelines seems logical, but its evidence base is in fact limited and with markedly conflicting data (detailed in Supplementary table A). [12][13][14][15][16][17][18] Previous studies, conducted in Asia and North America, have solely focused on diagnostic outcomes of colonoscopy in those with suspected IBS using historic Rome I-III criteria, except for a study from Nepal which used the Rome IV criteria albeit before it had been translated and validated to non-English speaking languages. They also appear to have partially assessed for alarm features, such as failing to enquire about family history of GI cancer/inflammatory bowel disease and not performing laboratory tests for inflammation, leading to widely discrepant colonoscopy outcome data and subsequent clinical uncertainty.…”

“…Surprisingly, some groups also appear to have performed a greater proportion of colonoscopies in patients without alarm features than with alarm features, which is contrary to our own anecdotal clinical experience (Supplementary table A). [12][13][14][15][16][17][18] Finally, there is no colonoscopy outcome data for other FBDs, such as functional constipation or functional diarrhea, which have become increasingly prevalent following the recent publication of the Rome IV criteria and commonly seek healthcare. 2 Thus, we aimed to perform the first study to evaluate the diagnostic yield of colonoscopy across the spectrum of FBDs whilst using the contemporaneous Rome IV criteria, and having stratified diligently in accordance with the presence or absence of alarm features.…”

Expression and diagnostic value of miR‑34c and miR‑141 in serum of patients with colon cancer

“…Its morbidity and mortality worldwide are gradually increasing, posing a great threat to human life (1). There is lack of specific early stage symptoms and the digestive system signs appear in the middle and late stages, which can cause serious adverse effects (2,3). At present, the main treatment for clinical colon cancer is still surgical resection, but due to the lack of sensitive diagnostic indicators, most patients have already developed lymph nodes or distant metastases at the time of diagnosis, and the surgical resection rate and prognosis are not ideal (4,5).…”