"Red flag" evaluation yield in irritable bowel syndrome

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.

This investigation was designed to examine the yield of testing for "red flags".

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 also reviewed.

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.

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.