Overlapping of irritable bowel syndrome with erosive esophagitis and the performance of Rome criteria in diagnosing IBS in a clinical setting

Abstract

Irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) overlap. It is not clear whether GERD is caused by non‑erosive esophagitis, or erosive esophagitis. The Rome criteria are not widely used for the diagnosis of IBS in the clinic. In total, 1,489 IBS patients without red flags were included in the present retrospective study. They comprised of 1,331 females and 158 males with a mean age of 51 years. The diagnosis of IBS was verified by endoscopic and histopathological examinations. Whereas erosive esophagitis occurred in 97% of patients, only 66% had GERD symptoms. Endoscopy and histopathological examinations revealed that 1.4% of the IBS patients with diarrhea as the predominant symptom had other organic gastrointestinal diseases: 0.3% with celiac disease, 0.2% with Crohn's disease, 0.07% with ulcerative colitis, 0.6% with microscopic colitis, and 0.2% with colon cancer. Applying the Rome III criteria produced a sensitivity of 100% [95% confidence intervals (CI)=99.8‑100.0%] a specificity of 98.7% (95% CI=98.0‑99.2%), a positive likelihood ratio of 76.9%, and a negative likelihood ratio of 0%. IBS is associated with erosive esophagitis. Applying Rome III criteria without red flags and history, was effective in diagnosing IBS. Celiac disease and microscopic colitis should be considered as alternative diagnoses.

Figure 1.

Photomicrograph of the duodenum of a 24-year-old female diagnosed with irritable bowel syndrome based on Rome III criteria, who was found to suffer from celiac disease of Marsh type 1. The section was immunostained for CD45, which is a common leukocyte antigen and is expressed exclusively on cells of the hematopoietic system and their progenitors. Scale bar, 50 µm.

Figure 2.

Endoscopic appearance of the terminal ileum with aphthoid ulcers in a 32-year-old female who fulfilled the Rome III criteria. A histopathological examination confirmed the diagnosis of Crohn's disease.

Figure 3.

Photograph of the sigmoid colon taken during the colonoscopy of a 57-year-old female diagnosed with IBS based on Rome III criteria. A histopathological examination confirmed the diagnosis of ulcerative colitis.

Figure 4.

A tumor in the sigmoid colon observed during the colonoscopy of a 56-year-old male diagnosed with irritable bowel syndrome based on Rome III criteria. A histopathological examination showed that the tumor was an adenocarcinoma.

Figure 5.

Photomicrograph taken from the colon of a 42-year-old male who fulfilled the Rome III criteria. A histopathological examination revealed the presence of collagenous colitis. The section showed positive immunostaining for collagen III. Scale bar, 50 µm.