FUNCTIONAL DIAGNOSTIC WORK-UP IN PATIENTS WITH IRRITABLE-BOWEL-SYNDROME

The first aim of the study was to find a cause of symptoms in patients suffering from ''irritable bowel syndrome'' using diagnostic tests ai med a functional disorders of lower gut. A second aim was to test, whe ther the presence of irritable bowel syn drome (or, synonymously, abse nce of classic organic disease) can be predicted by specific symptoms. 134 consecutive patients (50 +/- 16 SD years, range 17 to 88, 94 wome n) presenting in our gastroenterological outpatient department with ab dominal pain and altered bowel habits were included. A conventional di agnostic work-up aimed at classic organic diseases and, ii negative, a functional diagnostic work-up aimed at gastrointestinal malfunction s uch as dietary fibre trial, functional proctoscopy, defecography, colo nic transit of radiopaque markers, anorectal manometry, and lactose to lerance test were done. A classic organic disease was found in only 15 of 134 patients by conventional diagnostic tests. Functional diagnost ic work-up yielded a diagnosis in 70 of the remaining 119 patients tha t else would have been labeled to suffer from IBS (25 slow transit con stipation, 20 disordered defecation, nine low fibre intake, and nine l actose intolerance among them). When symptoms were evaluated with a st andardized questionnaire, ''constipation'' and the ''necessity of stra ining to open bowels'' were very specific for functional bowel disorde r (92% and 100%), but sensitivity of both symptoms was only about 60%. The so-called ''Manning criteria'' had a very low prevalence in our s ample and so were not discriminatory. Since in more than half of the p atients with ''irritable bowel syndrome'' a specific diagnosis can be reached, functional tests should be considered in such patients. The s ymptom ''constipation'' in patients with-lower gut complaints predicte d a functional disorder rather than a classic organic disease with a h igh specificity.