Application of the Rome III criteria is not likely to reduce the number of unnecessary referrals for colonoscopy in primary care

Objective To determine to what extent the Rome III criteria for irritable bowel syndrome can contribute towards safely reducing unnecessary referrals for colonoscopy in primary care patients with lower gastrointestinal (GI) complaints. Design Data from the CEDAR study were used: a cross-sectional study in 810 patients with lower GI complaints suggestive for organic bowel disease who were referred by their general practitioner for secondary care colonoscopy. Fulfilment of the Rome III criteria was ascertained by a questionnaire. General practitioners recorded the presence or absence of alarm symptoms. Outcome was determined by colonoscopy and histology. Results Of 810 participants, 222 fulfilled the Rome III criteria [27%, 95% confidence interval (CI) 24-31%]. The majority of these patients presented with alarm symptoms. Only 39 participants fulfilled the Rome III criteria and lacked alarm symptoms (overall frequency 5%, 95% CI 4-7). Overall, organic bowel disease was diagnosed in 141 participants (17%). Participants who fulfilled the Rome III criteria had a significantly lower risk of organic bowel disease compared with participants who did not [12% (95% CI 8-17) vs. 20% (95% CI 17-23), P<0.01]. The lowest risk was observed in patients without alarm symptoms who fulfilled the Rome III criteria (3%, 95% CI 0-14). Conclusion A minority of referred primary care patients with lower GI complaints both fulfilled the Rome III criteria for irritable bowel syndrome and lacked alarm symptoms. Although organic bowel disease could be ruled out safely in this small group, application of the Rome III criteria is not likely to lead to a considerable reduction in unnecessary referrals for colonoscopy in these patients. Eur J Gastroenterol Hepatol 25:568-574