The Rational Clinical Examination
David L. Simel, Drummond Rennie
Irritable Bowel Syndrome
Alexander C. Ford, Nicholas J. Talley, Sander J. O. Veldhuyzen van Zanten, Nimish B. Vakil, David L. Simel, Paul Moayyedi
Kruis et al19 described a model that included a combination of symptoms, physical...
Topics Discussed:
diagnostic process, irritable bowel syndrome, kruis scoring system, meta-analyses, sensitivity, specificity, summarizing the evidence, systematic reviews
Excerpt:
"The search strategy identified 16 079 studies, of which 17 were
possibly relevant to the systematic review and retrieved (Figure
55-1).18,19,40–54 There was good agreement
between reviewers (88% agreement, 
= 0.73) when
eligibility criteria were assessed, and 10 studies evaluating a
total of 2355 patients were eligible for inclusion (Table 55-3),
with a summary prevalence of IBS of 57% (95% CI,
45% 68%).18,19,41,43–47,50,53 Of the 7 excluded studies, 5 did not provide extractable
data,48,49,51,52,54 1 excluded patients at
study entry on the basis of symptoms,40 and 1 used
the presence of nongastrointestinal symptoms to predict a diagnosis
of IBS.42The prevalence of IBS in the eligible studies varied from 21% to
78%. Only 1 study was partly based in primary care, and
this reported a prevalence of IBS of 60% among patients
with lower gastrointestinal tract symptoms,41 compared
with a pooled prevalence of 57% in the 9 secondary care–based
studies. Six of the studies reported prevalence of IBS according
to sex.19,41,43–45,50 The pooled prevalence
of IBS in males was 42% (95% CI, 26% 60%),
compared with 57% (95% CI, 38% 75%)
in females. Only 1 study reported a higher prevalence of IBS in
males (74%) compared with females (71%).50 Four
studies compared mean age between patients with IBS and those with
organic disease,41,43,44,50 and this was lower
in those with IBS in all 4 cases, though only 1 study stated that
this was statistically significant.41..."
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