Manning et al listed signs and symptoms commonly seen in patients with Irritable Bowel Syndrome (IBS) and which could help separate them from patients with organic bowel disease.
(1) A questionnaire listing 15 symptoms felt to common in patients with IBS was administered to patients coming to a gastrointestinal or surgical clinic with abdominal pain or change in bowel habits.
(2) Diagnosis was based on retrospective chart review.
Findings Found Useful for Separation
looser stools at onset of pain
p < 0.001
more frequent bowel movements at onset of pain
p < 0.01
pain eased after bowel movement, often
feeling of distension
0.05 < p < 0.1
mucus per rectum
feeling of incomplete emptying (often)
Table 1, page 654, Manning (1978)
Table 1, page 490, Kay (1998)
• The first 4 symptoms were significantly more common in patients with IBS.
• A feeling of distension is not included by Talley (1990) in his evaluation of the Manning criteria
The other 8 findings included in Manning's study were not found useful for identifying patients with IBS (Table 1, page 654, lower half)
(1) bowel movement before breakfast
(2) nocturnal bowel movement
(3) urgency of defecation
(4) pain worse before bowel movement
(5) pain relieved with flatus
(6) > 2 bowel movements between meals
(7) harder stools at onset of pain
(8) less frequent bowel movements at onset of pain
number of Manning criteria =
= SUM(number of findings present)
• In Manning's original study, >= 2 findings were found in 91% of patient's with irritable bowel syndrome and 30% of patients with organic disease.
Talley (1990) found that the Manning criteria were useful to distinguish irritable bowel syndrome patients from other patients with gastrointestinal disease, but were not highly sensitive
(1) distinction of IBS from organic gastrointestinal disease: sensitivity 58%; specificity 74%
(2) distinction of IBS from all non-IBS gastrointestinal disease: sensitivity 42%; specificity 85%
Limitations (Talley, 1991)
• The original questionnaire used was not formally validated.
• Diagnosis was based on retrospective chart review .
• Only a selected population of patients was evaluated.
• Statistical analysis was based on multiple comparison testing.
• Analysis was not controlled for age and sex.
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Purpose: To use the criteria of Manning et al. for irritable bowel syndrome (IBS).
Objective: criteria for diagnosis