Do published guidelines for evaluation of Irritable Bowel Syndrome reflect practice?

Yawn, Barbara P.; Lydick, Eva; Locke, G. Richard; Wollan, Peter C.; Bertram, Susan; Kurland, Margary

doi:10.1186/1471-230x-1-11

Cited by 19 publications

(22 citation statements)

References 18 publications

(14 reference statements)

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“…Most of the evidence relating to the importance of excluding alarm features must be inferred through indirect evidence from reports of longitudinal follow‐up of patients diagnosed with IBS who did not have alarm features. In one study, Yawn et al 41 reviewed the medical records of 149 patients diagnosed with IBS. During 3 years of follow‐up, one patient out of 149 (0.67%) was diagnosed with organic disease (IBD) felt to be responsible for their gastrointestinal symptoms.…”

Section: When Should Diagnostic Testing Be Considered?mentioning

confidence: 99%

Irritable bowel syndrome – an evidence‐based approach to diagnosis

Cash¹,

Chey²

2004

Aliment Pharmacol Ther

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Summary Irritable bowel syndrome (IBS) represents one of the most common reasons for primary care visits and consultation with a gastroenterologist. It is characterized by abdominal discomfort, bloating and disturbed defecation in the absence of any identifiable physical, radiologic or laboratory abnormalities indicative of organic gastrointestinal disease. IBS is a costly disorder, responsible for significant direct and indirect costs to patients and society. Much of the cost attributed to IBS arises from the time and resources used to establish the diagnosis. Historically IBS has been viewed by many as a diagnosis of exclusion rather than as a primary diagnosis, and many patients with typical symptoms will undergo an extensive array of diagnostic tests and procedures prior to the eventual diagnosis of IBS. Recent reviews addressing the management of such patients have cast doubt on the necessity for this degree of testing. Current best evidence does not support the routine use of blood tests, stool studies, breath tests, abdominal imaging or lower endoscopy in order to exclude organic gastrointestinal disease in patients with typical IBS symptoms without alarm features. Serological testing for celiac sprue in this population may eventually prove useful but validation of studies indicating an increased prevalence of this disease in patients with suspected IBS is needed. The development and refinement of symptom‐based criteria defining the clinical syndrome of IBS has greatly facilitated the diagnosis of this condition, which can be confidently diagnosed through the identification of typical symptoms, normal physical examination and the exclusion of alarm features. The presence of alarm features or persistent non‐response to symptom‐directed therapies should prompt a more detailed diagnostic evaluation dictated by the patient's predominant symptoms.

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Section: When Should Diagnostic Testing Be Considered?mentioning

confidence: 99%

Irritable bowel syndrome – an evidence‐based approach to diagnosis

Cash¹,

Chey²

2004

Aliment Pharmacol Ther

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“…The final number of subjects was therefore 149. Data regarding the testing done at the time of the diagnosis have been published previously 5, 6 …”

Section: Data Collectionmentioning

confidence: 99%

“…The irritable bowel syndrome (IBS) is a clinical syndrome defined by a combination of abdominal pain associated with a change in bowel habit and features of disordered defecation, often with bloating, which is not explained by a structural or biochemical abnormality 1, 2 . IBS is a common condition 3, 4 resulting in multiple physician visits and substantial health care costs 5–8 . Still, only about 50% of people with IBS choose to seek care for their condition 3, 4 .…”

Section: Introductionmentioning

confidence: 99%

Incidence of a clinical diagnosis of the irritable bowel syndrome in a United States population

Locke

Yawn

Wollan

et al. 2004

Aliment Pharmacol Ther

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Summary Background : The incidence of irritable bowel syndrome is uncertain. We aimed to determine the incidence of clinically diagnosed irritable bowel syndrome in the community. Methods : Using the Rochester Epidemiology Project, all diagnoses of irritable bowel syndrome made among adult residents of Olmsted County, Minnesota, over a 3‐year period were identified. The complete medical records of a random sample of the potential subjects were reviewed for the 10 years prior to the irritable bowel syndrome diagnosis and any patient who had received a previous diagnosis of irritable bowel syndrome was excluded (prevalent cases). Results : The diagnostic index listed 1245 possible irritable bowel syndrome patients; 416 patient charts were reviewed and, of these, 149 were physician diagnosed incident cases of irritable bowel syndrome. The age‐ and sex‐adjusted incidence rate was 196 per 100 000 person‐years and increased with age (P = 0.006). The age‐adjusted annual incidence per 100 000 in women was higher than in men: 238 vs. 141 (ratio 3:2; P = 0.005). The overall symptom frequency at the time of diagnosis was abdominal pain (73%), diarrhoea (41%) and constipation (16%). Conclusions : The incidence of a clinical diagnosis of irritable bowel syndrome in adults was estimated to be two per 1000 per year, increased with age and was higher in women than men. As many people with irritable bowel syndrome do not seek care, the true incidence of irritable bowel syndrome is likely to be higher.

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“…The latter is not often the case, as was shown in a number of studies: Of all patients (n=148) who matched the primary care definition of IBS, only 62% and 18% fulfilled the Manning and Rome II criteria, respectively, according to a Dutch investigation [37]. A study by Yawn et al [38] showed that not one of 149 IBS patients was diagnosed according to the gastroenterological standards set by the respective professional society (USA: American Gastroenterology Association, American College of Gastroenterology) at their family physician, and especially the request for a (negative) colonoscopy was met in only 41% of cases.…”

Section: Psychosomatics/psychiatrymentioning

confidence: 89%