Moayyedi et al reported clinical findings that may indicate a significant underlying pathology in a patient presenting with symptoms of irritable bowel syndrome (IBS). Identifiication of an underlying pathology may signifiicantly change patient management. The authors are from McMaster University and multiple institutions in Europe.
Patient selection: patient presenting with symptoms of irritable bowel syndrome
Alarm signs:
(1) onset age >= 50 years
(2) blood in stool not explained by hemorrhoids or anal fissure
(3) unintended weight loss
(4) unexplained anemia
(5) family history of celiac disease, inflammatory bowel disease or cancer
(6) abdominal mass
(7) ascites
(8) leukocytosis
(9) anorexia (loss of appetite)
(10) nocturnal symptoms
(11) unexplained fever
(12) recent change in symptoms
where:
• Items 3 and 11 are constitutional B symptoms. Night sweats is another.
The concern should increase with the number of alarm signs identified.
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