An exploration of the barriers to the confident diagnosis of irritable bowel syndrome: A survey among general practitioners, gastroenterologists and experts in five European countries

Abstract

Background: The diagnostic processes for chronic abdominal conditions are challenging. Despite their tendency for diagnostic tests in patients with irritable bowel syndrome (IBS) symptoms, clinicians are encouraged to make a positive diagnosis based on symptom criteria without alarm signs. We explored how European physicians diagnose and manage patients suffering from IBS. Methods: We conducted a vignette-based survey to evaluate the diagnostic approaches in four standardized patients with IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), inflammatory bowel disease (IBD) and chronic constipation (CC). General practitioners (GP, n ¼ 104), gastroenterologists (GE, n ¼ 100) and IBS experts (n ¼ 25) from five European countries participated. Results: Experts showed the highest rates of correct diagnoses (88%-92%) for all cases except CC (only 60%) and were more prone to a positive diagnosis (64%/68% in IBS-C/CC), whereas GEs and GPs tended toward a diagnosis by exclusion (63%/ 63% and 62%/60% in IBS-C/CC). In the CC vignette, conducting tests was more frequent than prescribing treatment among 44% experts, 63% GEs and 36% GPs. The diagnosis of IBD presented little difficulty for any of the participants. Conclusions: This study highlights the difficulties in confidently diagnosing chronic functional bowel conditions, especially for non-experts, whereas IBD caused little difficulty. Differentiating between IBS-C and CC seemed particularly challenging, even for experts.

Ameliorative effects of atractylodin on intestinal inflammation and co-occurring dysmotility in both constipation and diarrhea prominent rats

“…Diarrhea, constipation and intestinal inflammation are the main symptoms of the patients with IBD and IBS [1112]. Clinical and epidemiological studies indicate that the inflammation is found from the jejunum to the rectum in both IBS and IBD [1314151617].…”

Irritable Bowel Syndrome – dissection of a disease

“…With the pressure to increasingly acknowledge pathophysiological concepts and to refrain from solely symptom-based diagnosis the problems will rather increase. Based on the numerous putative biomarkers that are now discussed in IBS and FD (and some for both diseases) [20], doors are widely open for special examinations, however, for a clinically undefined subpopulation. This would cause a cost explosion, for which there are initial indications [21].…”

Referrals to a tertiary hospital: A window into clinical management issues in functional gastrointestinal disorders

“…Recent studies have shown that most clinicians continue to regard IBS as a diagnosis of exclusion. 12,30 Only 52% of gastroenterologists and 34% of PHCPs were confident diagnosing IBS based on symptoms, history and physical exam, with less than half of these confident to inform the patient without further investigations. 12 This is also supported by the reluctance of PHCPs to add IBS read-codes to patient records until more serious pathology was excluded.…”