# symptom-based diagnosis



## Guest (Oct 10, 2001)

New Algorithm Helps Diagnose Irritable Bowel A DG review of: "Evidence- and Consensus-Based Practice Guidelines for the Diagnosis of Irritable Bowel Syndrome" - Archives of Internal MedicineBy Elda HauschildtA new diagnostic algorithm could help doctors identify patients with irritable bowel syndrome (IBS).A symptom-based approach is the basis of the algorithm. It also recommends referral to sub-specialists of patients with "alarm" symptoms. Radiographic, endoscopic and other tests are reserved for referral cases.North American researchers comment: "The resulting algorithm highlights the reliance on symptom criteria and comprises a primary module, three sub-modules based on the predominant symptom pattern - constipation, diarrhoea and pain - and severity level and a sub-specialist referral module."They point out that a dearth of available evidence "highlights the need for more rigorous scientific validation to identify the most accurate methods of diagnosing IBS."Until such time, the diagnostic algorithm could inform decision-making for a range of providers caring for primary-care patients with abdominal discomfort or pain and altered bowel function suggestive of IBS."Investigators from five centres in the United States state they wanted to use the "best available evidence, supplemented by expert opinion, to arrive at evidence- and consensus-based guidelines" for a diagnostic approach to patients suspected of having IBS.They did a systematic review of the literature from January 1966 to April 2000, using computerised bibliographic databases. They also convened an expert panel of specialists and primary care doctors to fill in gaps in the literature. They used a modified Delphi technique to develop consensus.The researchers found only 13 published studies on the effectiveness of competing diagnostic approaches to IBS, accuracy of diagnostic tests and internal validity of current diagnostic symptom criteria.They say the diagnostic algorithm they developed "represents an accumulation of the best available evidence and consensus-based expert opinion from a variety of practice settings."Investigators comment: "Further research is necessary to define the most accurate methods of patient identification and diagnosis."Studies should be performed using established methodological standards for diagnostic test evaluation and should compare the most commonly used criteria and diagnostic tests."Finally, a prospective evaluation of the impact of systematic approaches to care for patients with IBS should be performed to document the impact of guidelines on the cost-effectiveness and outcomes of care." tom


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