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Irritable bowel syndrome: diagnostic approaches in clinical practice.

Burbige EJ - Clin Exp Gastroenterol (2010)

Bottom Line: Traditional symptom-based criteria effectively identify IBS patients but are not easily applied in clinical practice, leaving >40% of patients to experience symptoms up to 5 years before diagnosis.The American Gastroenterological Association and American College of Gastroenterology recommend diagnosing IBS in patients without alarm features of organic disease using symptom-based criteria (eg, Rome).However, physicians report confidence in a symptom-based diagnosis without further testing only up to 42% of the time; many order laboratory tests and perform sigmoidoscopies or colonoscopies despite good evidence showing no utility for this work-up in uncomplicated cases.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Gastrointestinal and Liver Research, John Muir Medical Center, Concord, CA, USA.

ABSTRACT

Background: Irritable bowel syndrome (IBS), a functional gastrointestinal disorder long considered a diagnosis of exclusion, has chronic symptoms that vary over time and overlap with those of non-IBS disorders. Traditional symptom-based criteria effectively identify IBS patients but are not easily applied in clinical practice, leaving >40% of patients to experience symptoms up to 5 years before diagnosis.

Objective: To review the diagnostic evaluation of patients with suspected IBS, strengths and weaknesses of current methodologies, and newer diagnostic tools that can augment current symptom-based criteria.

Methods: The peer-reviewed literature (PubMed) was searched for primary reports and reviews using the limiters of date (1999-2009) and English language and the search terms irritable bowel syndrome, diagnosis, gastrointestinal disease, symptom-based criteria, outcome, serology, and fecal markers. Abstracts from Digestive Disease Week 2008-2009 and reference lists of identified articles were reviewed.

Results: A disconnect is apparent between practice guidelines and clinical practice. The American Gastroenterological Association and American College of Gastroenterology recommend diagnosing IBS in patients without alarm features of organic disease using symptom-based criteria (eg, Rome). However, physicians report confidence in a symptom-based diagnosis without further testing only up to 42% of the time; many order laboratory tests and perform sigmoidoscopies or colonoscopies despite good evidence showing no utility for this work-up in uncomplicated cases. In the absence of diagnostic criteria easily usable in a busy practice, newer diagnostic methods, such as stool-form examination, fecal inflammatory markers, and serum biomarkers, have been proposed as adjunctive tools to aid in an IBS diagnosis by increasing physicians' confidence and changing the diagnostic paradigm to one of inclusion rather than exclusion.

Conclusion: New adjunctive testing for IBS can augment traditional symptom-based criteria, improving the speed and safety with which a patient is diagnosed and avoiding unnecessary, sometimes invasive, testing that adds little to the diagnostic process in suspected IBS.

No MeSH data available.


Related in: MedlinePlus

Laboratory and diagnostic tests commonly ordered, presented by physician type.32 More than 1 response could be chosen. A, Laboratory tests by practice type. “Other” laboratory tests (≤2%) are not represented. B, Diagnostic tests by practice type. “Other” diagnostic tests (4%–11%) and “no studies ordered” (34%–38%) are not represented. P values are shown.Abbreviations: GI, gastrointestinal; CBC, complete blood count; ESR, erythrocyte sedimentation rate; LFT, liver function test; TFT, thyroid function test; FOBT, fecal occult blood test; EGD, esophagogastroduodenoscopy; SBFT, small bowel follow-through.
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f1-ceg-3-127: Laboratory and diagnostic tests commonly ordered, presented by physician type.32 More than 1 response could be chosen. A, Laboratory tests by practice type. “Other” laboratory tests (≤2%) are not represented. B, Diagnostic tests by practice type. “Other” diagnostic tests (4%–11%) and “no studies ordered” (34%–38%) are not represented. P values are shown.Abbreviations: GI, gastrointestinal; CBC, complete blood count; ESR, erythrocyte sedimentation rate; LFT, liver function test; TFT, thyroid function test; FOBT, fecal occult blood test; EGD, esophagogastroduodenoscopy; SBFT, small bowel follow-through.

Mentions: Lacy et al32 analyzed survey responses from 472 gastroenterologists, internists, and family physicians to ascertain their understanding of IBS and practice patterns. Although the physicians reported feeling capable of diagnosing IBS at the initial visit without further testing in patients without alarm features up to 42% of the time, the majority of gastroenterologists report commonly ordering laboratory tests and nearly one-third will perform flexible sigmoidoscopies or colonoscopies (Figure 1).32 All three types of physicians reported a primary goal of excluding organic disease, with symptom relief being only of secondary importance. Overall, IBS symptoms account for nearly 25% of colonoscopies in patients younger than 50 years.2,37,38


Irritable bowel syndrome: diagnostic approaches in clinical practice.

Burbige EJ - Clin Exp Gastroenterol (2010)

Laboratory and diagnostic tests commonly ordered, presented by physician type.32 More than 1 response could be chosen. A, Laboratory tests by practice type. “Other” laboratory tests (≤2%) are not represented. B, Diagnostic tests by practice type. “Other” diagnostic tests (4%–11%) and “no studies ordered” (34%–38%) are not represented. P values are shown.Abbreviations: GI, gastrointestinal; CBC, complete blood count; ESR, erythrocyte sedimentation rate; LFT, liver function test; TFT, thyroid function test; FOBT, fecal occult blood test; EGD, esophagogastroduodenoscopy; SBFT, small bowel follow-through.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108663&req=5

f1-ceg-3-127: Laboratory and diagnostic tests commonly ordered, presented by physician type.32 More than 1 response could be chosen. A, Laboratory tests by practice type. “Other” laboratory tests (≤2%) are not represented. B, Diagnostic tests by practice type. “Other” diagnostic tests (4%–11%) and “no studies ordered” (34%–38%) are not represented. P values are shown.Abbreviations: GI, gastrointestinal; CBC, complete blood count; ESR, erythrocyte sedimentation rate; LFT, liver function test; TFT, thyroid function test; FOBT, fecal occult blood test; EGD, esophagogastroduodenoscopy; SBFT, small bowel follow-through.
Mentions: Lacy et al32 analyzed survey responses from 472 gastroenterologists, internists, and family physicians to ascertain their understanding of IBS and practice patterns. Although the physicians reported feeling capable of diagnosing IBS at the initial visit without further testing in patients without alarm features up to 42% of the time, the majority of gastroenterologists report commonly ordering laboratory tests and nearly one-third will perform flexible sigmoidoscopies or colonoscopies (Figure 1).32 All three types of physicians reported a primary goal of excluding organic disease, with symptom relief being only of secondary importance. Overall, IBS symptoms account for nearly 25% of colonoscopies in patients younger than 50 years.2,37,38

Bottom Line: Traditional symptom-based criteria effectively identify IBS patients but are not easily applied in clinical practice, leaving >40% of patients to experience symptoms up to 5 years before diagnosis.The American Gastroenterological Association and American College of Gastroenterology recommend diagnosing IBS in patients without alarm features of organic disease using symptom-based criteria (eg, Rome).However, physicians report confidence in a symptom-based diagnosis without further testing only up to 42% of the time; many order laboratory tests and perform sigmoidoscopies or colonoscopies despite good evidence showing no utility for this work-up in uncomplicated cases.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Gastrointestinal and Liver Research, John Muir Medical Center, Concord, CA, USA.

ABSTRACT

Background: Irritable bowel syndrome (IBS), a functional gastrointestinal disorder long considered a diagnosis of exclusion, has chronic symptoms that vary over time and overlap with those of non-IBS disorders. Traditional symptom-based criteria effectively identify IBS patients but are not easily applied in clinical practice, leaving >40% of patients to experience symptoms up to 5 years before diagnosis.

Objective: To review the diagnostic evaluation of patients with suspected IBS, strengths and weaknesses of current methodologies, and newer diagnostic tools that can augment current symptom-based criteria.

Methods: The peer-reviewed literature (PubMed) was searched for primary reports and reviews using the limiters of date (1999-2009) and English language and the search terms irritable bowel syndrome, diagnosis, gastrointestinal disease, symptom-based criteria, outcome, serology, and fecal markers. Abstracts from Digestive Disease Week 2008-2009 and reference lists of identified articles were reviewed.

Results: A disconnect is apparent between practice guidelines and clinical practice. The American Gastroenterological Association and American College of Gastroenterology recommend diagnosing IBS in patients without alarm features of organic disease using symptom-based criteria (eg, Rome). However, physicians report confidence in a symptom-based diagnosis without further testing only up to 42% of the time; many order laboratory tests and perform sigmoidoscopies or colonoscopies despite good evidence showing no utility for this work-up in uncomplicated cases. In the absence of diagnostic criteria easily usable in a busy practice, newer diagnostic methods, such as stool-form examination, fecal inflammatory markers, and serum biomarkers, have been proposed as adjunctive tools to aid in an IBS diagnosis by increasing physicians' confidence and changing the diagnostic paradigm to one of inclusion rather than exclusion.

Conclusion: New adjunctive testing for IBS can augment traditional symptom-based criteria, improving the speed and safety with which a patient is diagnosed and avoiding unnecessary, sometimes invasive, testing that adds little to the diagnostic process in suspected IBS.

No MeSH data available.


Related in: MedlinePlus