Irritable Bowel Syndrome in Primary Care: The Patients’ and Doctors’ Views on Symptoms, Etiology and Management

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Abstract

BACKGROUND: To facilitate the development of clinical guidelines and to direct future irritable bowel syndrome (IBS) research, insight into the perceptions of patients and general practitioners (GPs) regarding IBS is required.

OBJECTIVES : To compare patients’ and GPs’ views on the symptomatology, etiology and treatment of IBS. METHODS: One hundred forty-two IBS patients and 100 GPs were requested to complete a structured questionnaire.

RESULTS: The response rates of the patients and GPs were 80% and 47%, respectively. Abdominal pain and bloating were considered to be the most bothersome symptoms in IBS, by both patients and GPs. Although all patients were diagnosed by their GP as having IBS, and 62% met the Manning criteria, only 18% fulfilled the Rome II criteria for IBS. Patients consider food intolerance and GPs regard lack of fibre as the main etiologic dietary factor. Many IBS patients expect a diagnostic work-up, but GPs generally restrict this to elderly patients. GPs start IBS management with dietary advice (94%), counselling (77%) and drug therapy (55%). Patients expect reassurance (47%) and drug treatment (37%), but dietary interventions are less appreciated (9%).

CONCLUSIONS: Patients and GPs have different perceptions of the efficacy of diagnostic and dietary interventions in IBS. GPs should explore the patients expectations and incorporate these in their approach to IBS patients.

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Most cited references 21

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Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time.

Lars Agreus, Kurt Svärdsudd, Olof Nyrén … (1995)

It has been suggested that irritable bowel syndrome (IBS) and functional dyspepsia represent the same disease entity, the irritable gut. The aim of this study was to test the stability, consistency, and relevance of the current classification in the entire, unselected population of persons with gastrointestinal and/or abdominal symptoms, including those who had not consulted physicians. Sequential postal questionnaires were sent to 1290 representative persons (age range, 20-79 years) sampled from the population. Questions were asked about the prevalence of 24 gastrointestinal and/or abdominal symptoms and the site and type of abdominal pain, if any. The prevalence of dyspepsia was 14% (32% if predominant reflux symptoms and concomitant IBS symptoms were included), and the prevalence of IBS was 12.5%. The 3-month incidence rates of reflux, dyspepsia, and IBS among previously symptomless persons were 0.5, 8, and 2 per 1000, respectively. Of persons with IBS, 87% also fulfilled the dyspepsia criteria, and the overlap between dyspepsia subgroups was more than 50%. The use of stricter criteria did not eliminate this overlap. Over a 1-year period, approximately 50% changed their symptom profile. Principal component analysis did not show any natural clustering of the symptoms. The separation of functional gastrointestinal symptoms into dyspepsia, its subgroups, and IBS may be inappropriate.

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Irritable bowel syndrome in the general population.

S Lydeard, Jonathan Jones (1992)

To determine the prevalence of symptoms compatible with a clinical diagnosis of irritable bowel syndrome in the general population. Validated postal questionnaire sent to 2280 subjects randomly selected in 10 year age bands from the lists of eight general practitioners. The Manning criteria were used to define irritable bowel syndrome. Urban population in Southampton and mixed urban-rural population in Andover, Hampshire. A response of 71% yielded 1620 questionnaires for analysis, of which 412 (25%) reported more than six episodes of abdominal pain in the preceding year, with 350 (22%) reporting symptoms consistent with the diagnosis of irritable bowel syndrome. The male: female ratio was 1:1.38. More subjects with irritable bowel syndrome had constipation and diarrhoea and 35% with the syndrome reported rectal bleeding compared with an overall prevalence of 20%. Other symptoms and conditions including heartburn, dyspepsia, flushing, palpitations, migraine, and urinary symptoms were significantly more common in the group with irritable bowel syndrome. Abdominal pain in childhood was more common in the subjects with irritable bowel syndrome (12%) than without (3%). One third of the group with irritable bowel syndrome had sought medical advice during the study period (male:female ratio 1:1.21); consultation behaviour was influenced by age and the presence of associated symptoms, varied considerably among patients registered with different general practitioners, and was poorly correlated with symptom severity. Symptoms consistent with a diagnosis of irritable bowel syndrome are present in almost one quarter of the general population and tend to be associated with a number of other complaints and conditions, some of which may reflect smooth muscle dysfunction.