Kruis Score for Diagnosis of Irritable Bowel Syndrome (IBS)
- Patients with highly suspected IBS as a possible confirmatory test.
- Patients with equivocal symptoms but with an initial negative workup to suggest if further workup should be pursued prior to diagnosing IBS.
- The Kruis Score helps to different IBS from organic bowel disease.
- It uses symptoms and lab testing to suggest which patients likely have IBS (high specificity).
- It is intentionally not a highly “sensitive” test, since IBS is often a diagnosis of exclusion.
Points to keep in mind:
As IBS is often a diagnosis of exclusion, often it is appropriate to begin with route lab and/or imaging testing in patients where clinicians have some possible suspicion of organic ideas.
The Kruis Score can help objectify and validate clinician suspicion of a patient with IBS.
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From the Creator
How do you use the Kruis Score for IBS in your own clinical practice? Can you give an example of a scenario in which you use it?
I’m retired, so I can only report my past use of the score.
Most important are the clinical questions. In patients suspicious of nonorganic complaints, I was always checking—for myself and during rounds with my young coworkers or during teaching rounds with students—does the history of the respective patients fit into the score?
If the history fitted well, my aim was to prevent the patient from extensive diagnosis of exclusion (according to the score).
Why did you develop the Kruis Score for IBS? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?
As a young clinical researcher, it was my task to collect patients with IBD. Soon I noticed that most patients with multiple symptoms don’t have IBD, but rather non-organic disease. Looking for the literature, I was very much impressed by Manning’s paper "Towards positive diagnosis of the irritable bowel.” But in intense discussions, it became clear that there is not only a positive diagnosis necessary but also a concise exclusion diagnosis. In reality, no one would fix a diagnosis exclusively on grounds of the history.
What pearls, pitfalls and/or tips do you have for users of the Kruis Score for IBS? Do you know of cases when it has been applied, interpreted, or used inappropriately?
I think the score is still valid (see also a review by R. Spiller). It should be re-evaluated again, focusing for exclusion on more modern procedures such as ultrasound or measurement of transglutaminase antibodies (to exclude celiac disease). As concerns the history, one could think about an additional history about preceding infectious disease as a cause of IBS.
Any other research in the pipeline that you're particularly excited about?
Yes, microbiota (microbiome) in IBS as a tool to make a more specific diagnosis and to guide therapeutic concepts (I have just submitted original work).
About the Creator
Wolfgang Kruis, MD, has practiced as an internist and professor of medicine at the Clinic for Gastroenterology, Pulmonology and General Internal Medicine at the Evangelical Hospital Kalk, teaching hospital of the University of Cologne, Germany. He has published more than 240 original articles in multiple international journals and has contributed to over 20 German textbooks for internal medicine and gastroenterology.
To view Dr. Wolfgang Kruis's publications, visit PubMed