Alternative investigations for irritable bowel syndrome

Background and Aim: Alternative and complementary medical practitioners have long advocated alternative treatments for irritable bowel syndrome. A more recent development has been the use of alternative investigations by these practitioners and, in the era of internet advertising, directly by patients themselves. The aim of the present study was to examine the alternative investigations that are advocated for the assessment of gastrointestinal disease and that are available through mainstream laboratories in Australia. Methods: A comprehensive literature review was undertaken for each investigation, which was then evaluated on the basis of ACCE criteria for diagnostic tests. The ACCE criteria consider the analytical and clinical validity, clinical utility and ethical implications of the test. Results: Serum immunoglobulin G (IgG) to food antigens, salivary IgA, intestinal permeability, fecal short-chain fatty acids and fecal microbial analysis were identified as readily available. None of the investigations satisfied the ACCE criteria. The tests were deficient in one or more areas of analytical validity, clinical application, validity and ethical usage standards. Conclusion: Alternative investigations lack reliability and direct clinical applications, and should not be recommended for the investigation of gastrointestinal symptoms.