The Rome III Criteria for the Diagnosis of Functional Dyspepsia in Secondary Care Are Not Superior to Previous Definitions

BACKGROUND & AIMS: Although the Rome III criteria for functional dyspepsia were defined 7 years ago, they have yet to be validated in a rigorous study. We addressed this issue in a secondary-care population. METHODS: We analyzed complete symptom, upper gastrointestinal (GI) endoscopy, and histology data from 1452 consecutive adult patients with GI symptoms at 2 hospitals in Hamilton, Ontario, Canada. Assessors were blinded to symptom status. Individuals with normal upper GI endoscopy and histopathology findings from analyses of biopsy specimens were classified as having no organic GI disease. The reference standard used to define the presence of true functional dyspepsia was epigastric pain, early satiety or postprandial fullness, and no organic GI disease. Sensitivity, specificity, and positive and negative likelihood ratios (LRs), with 95% confidence intervals (CIs), were calculated. RESULTS: Of the 1452 patients, 722 (49.7%) met the Rome III criteria for functional dyspepsia. Endoscopy showed organic GI disease in 170 patients (23.5%) who met the Rome III criteria. The Rome III criteria identified patients with functional dyspepsia with 60.7% sensitivity, 68.7% specificity, a positive LR of 1.94 (95% CI, 1.69-2.22), and a negative LR of 0.57 (95% CI, 0.52-0.63). In contrast, the Rome II criteria identified patients with functional dyspepsia with 71.4% sensitivity, 55.6% specificity, a positive LR of 1.61 (95% CI, 1.45-1.78), and a negative LR of 0.51 (95% CI, 0.45-0.58). The area under a receiver operating characteristics curves did not differ significantly for any of the diagnostic criteria for functional dyspepsia. CONCLUSIONS: In a validation study of 1452 patients with GI symptoms, the Rome III criteria performed only modestly in identifying those with functional dyspepsia, and were not significantly superior to previous definitions

Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care

BACKGROUND & AIMS: There are few validation studies of existing diagnostic criteria for irritable bowel syndrome (IBS). We conducted a validation study of the Rome and Manning criteria in secondary care. METHODS: We collected complete symptom, colonoscopy, and histology data from 1848 consecutive adult patients with gastrointestinal symptoms at 2 hospitals in Hamilton, Ontario; the subjects then underwent colonoscopy. Assessors were blinded to symptom status. Individuals with normal colonoscopy and histopathology results, and no evidence of celiac disease, were classified as having no organic gastrointestinal disease. The reference standard used to define the presence of true IBS was lower abdominal pain or discomfort in association with a change in bowel habit and no organic gastrointestinal disease. Sensitivity, specificity, and positive and negative likelihood ratios, with 95% confidence intervals, were calculated for each diagnostic criteria. RESULTS: In identifying patients with IBS, sensitivities of the criteria ranged from 61.9% (Manning) to 95.8% (Rome I), and specificities from 70.6% (Rome I) to 81.8% (Manning). Positive likelihood ratios ranged from 3.19 (Rome II) to 3.39 (Manning), and negative likelihood ratios from 0.06 (Rome I) to 0.47 (Manning). The level of agreement between diagnostic criteria was greatest for Rome I and Rome II (κ = 0.95), and lowest for Manning and Rome III (κ = 0.59). CONCLUSIONS: Existing diagnostic criteria perform modestly in distinguishing IBS from organic disease. There appears to be little difference in terms of accuracy. More accurate ways of diagnosing IBS, avoiding the need for investigation, are required

Detección de pólipos, adenomas, adenomas avanzados y adenocarcinomas de colon en pacientes entre 45 y 49 años

Antecedentes. El cáncer colorrectal (CCR) es prevenible, motivo por el cual se recomienda su pesquisa a partir de los 50 años. En 2002, Imperiale realizó el rastreo en individuos entre 40 y 49 años evidenciando adenomas y lesiones avanza - das en 8,5% y 3,5%, respectivamente. No obstante, aún no existen recomendaciones para el rastreo en individuos meno - res de 50 años. Objetivo. Estimar la prevalencia de pólipos, adenomas, adenomas avanzados y adenocarcinoma entre 45 y 49 años. Métodos. Se incluyeron consecutivamente adul - tos entre 45 y 49 años que realizaron una videocolonoscopía (VCC) por signos de alarma y/o síntomas. Fueron criterios de exclusión un alto riesgo para CCR, una VCC incompleta o evidencias previas de lesiones colónicas. El estudio se rea - lizó en un centro de gastroenterología de Buenos Aires en - tre setiembre de 2010 y octubre de 2011. Se hizo un diseño descriptivo, prospectivo y transversal. La limpieza colónica se realizó con polietilenglicol (PEG) o fosfatos. Las VCC se realizaron con equipos Olympus bajo sedación. Se calcularon los intervalos de confianza del 95% (IC 95%). El protoco - lo fue aprobado por el Comité Institucional. Resultados. Se evaluaron 814 pacientes y se incluyeron 764. Eran mujeres 440 pacientes (57%), con una edad promedio de 47 años. La prevalencia de pólipos fue 20% (160 casos, IC 95% 18% - 24%). La prevalencia de adenomas, incluyendo los avan - zados, fue 14% (107 casos, IC 95% 11% - 16%). La pre - valencia de adenomas avanzados exclusivamente fue 5% (39 casos, IC 95% 4% - 7%) y la de adenocarcinomas 0,1% (1 caso, IC 95% 0% - 0,7%). Conclusiones. La prevalencia de lesiones en esta población es inferior a la de los individuos con riesgo promedio. Por el momento, entendemos que no habría evidencia para indicar el rastreo en esta población

Adherencia de la población médica a los programas de rastreo de cáncer colorrectal: ¿Cuál es el cumplimiento de esta medida preventiva entre los profesionales?

Antecedentes. El rastreo de cáncer colorrectal (CCR) está recomendado pues su detección precoz mejora la sobrevida y reduce la mortalidad. No obstante, su cumplimiento en la población general es del 50% y en médicos aún menor. Objetivos. 1) Estimar el porcentaje de médicos que realizó el rastreo. 2) Estimar la frecuencia de los diferentes métodos de rastreo utilizados. Métodos. Se realizaron 269 encuestas a médicos con edad de 50 años o más de cuatro hospitales y cuatro eventos científicos en 2008. La encuesta validada incluyó especialidad, historia familiar, adherencia al rastreo, síntomas y edad al momento del rastreo, método utilizado, causas de haber realizado o no el rastreo, y resultados. Resultados. Se incluyeron 242 encuestas (respuesta del 90%). La edad promedio fue 58+6 años y el 98,3% de los encuestados ejercía su profesión. Las especialidades se agruparon en clínicas (72%), quirúrgicas (18%) y otras (9%). Cien médicos realizaron el rastreo [41% (IC 95% 35-47)].El método más utilizado fue la videocolonoscopía [70% (IC 95% 60-78)], seguida por el colon por enema con doble contraste [10% (IC 95% 5-18)]. De los médicos que realizaron el rastreo, 36% tenían historia familiar de CCR, 63% la negaron y 1% la desconocía. Fueron razones de no adherencia la decisión personal, el temor al procedimiento, la insuficiente información y la falta de tiempo. Conclusiones. La adherencia de los médicos al rastreo del CCR es sub-óptima. Nuevas estrategias deben implementarse para mejorar los hábitos de los médicos y el cumplimiento de los programas preventivos

Lack of utility of symptoms and signs at first presentation as predictors of inflammatory bowel disease in secondary care

OBJECTIVES:There are few data concerning the utility of symptoms and signs at first presentation in predicting a diagnosis of ulcerative colitis (UC) or Crohn's disease (CD). We conducted a study to examine this issue in secondary care.METHODS:We collected complete symptom, colonoscopy, and histology data prospectively from 1,981 consecutive adult patients with lower gastrointestinal symptoms at two hospitals in Hamilton, ON. Assessors were blinded to symptom status. The reference standard used to define the presence of UC or CD was according to accepted histological criteria. Patients without UC or CD served as controls. Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated for individual items from the clinical history, as well as combinations of these.RESULTS:In identifying 302 patients with inflammatory bowel diseases (IBD), positive LRs for individual items ranged from 1.18 (incomplete emptying) to 2.30 (passage of stools more than four times per day at least most of the time) and negative LRs from 0.70 (bloody stools) to 0.96 (incomplete emptying). Combinations of items had a high specificity, but at the expense of sensitivity. Items that were independent predictors of IBD after logistic regression analysis were family history of IBD, younger age, passage of stools more than four times per day ≥75% of the time, urgency most of the time, and anemia.CONCLUSIONS:Individual items from the clinical history are not helpful in predicting a diagnosis of UC or CD. However, this may be because some items lacked sufficient detail. Combinations of symptoms and computer models had a high specificity, but overall were only modestly useful diagnostically. Future studies should evaluate biological markers in combination with symptoms to improve accuracy