"Red Flag" Evaluation Yield in Irritable Bowel Syndrome
Full Article (PDF file)
Tyler P. Black, Catherine S. Manolakis, Jack A. Di Palma
Division of Gastroenterology, University of South Alabama College of Medicine, Mobile, Alabama, USA
Background: The diagnosis of irritable bowel syndrome
(IBS) is based on clinical criteria. Further diagnostic testing
is advised for certain "red flag" alarm or warning signs.
Aim: This investigation was designed to examine the yield of
testing for "red flags".
Methods: Consecutive patients who
were prospectively evaluated and met the ROME III criteria
for IBS were reviewed for "red flags" which included: 1)
rectal bleeding, 2) iron-deficiency anemia (IDA), 3) weight
loss, 4) family history of colon cancer, 5) fever, and 6) age of
onset after age 50. The evaluations were reviewed for type of
testing and findings. Subjects with nocturnal symptoms and
fecal soiling, although not traditional warning signs, were
Results: There were 200 patients who met
the IBS criteria; 139 (70%) had a "red flag" alarm symptom
or sign. Diarrhea predominant-IBS (D-IBS) was seen in 105,
constipation predominant-IBS (C-IBS) in 57, alternating,
mixed, or pain predominant-IBS in 38. There were 30 men
and 170 women. Testing was not often performed in this
setting and, when done, the yield was low with few clinically
significant diagnostic findings.
Conclusion: There was
a high prevalence of "red flag" symptoms or signs in the
prospectively evaluated IBS cohort, but a low frequency
of diagnostic testing directed at the investigation of these
symptoms or signs. Further systematic study may show that
the yield for testing in IBS is low even when "red flags"
prompt diagnostic testing.
Irritable bowel symptoms - alarm - diagnostic testing.