Diagnosis and management of irritable bowel syndrome: a guide for the generalist

Abstract

Irritable bowel syndrome (IBS) and other functional gastrointestinal disorders (FGIDs) are so prevalent they cannot reasonably have their diagnoses and management based within specialty care. However, delayed diagnosis, lengthy wait times for specialist review, overinvestigation and lack of clear diagnostic communication are common. The intrusive symptoms of IBS and other FGIDs impair patient functioning and reduce quality of life, and come with significant costs to individual patients and the health care system, which could be reduced with timely diagnosis and effective management. IBS, in particular, is no longer a diagnosis of exclusion, and there are now effective dietary and psychological therapies that may be accessed without specialist referral. The faecal calprotectin test is widely available, yet not on the Medical Benefits Schedule, and a normal test result reliably discriminates between people with IBS and patients who warrant specialist referral.

Faecal calprotectin testing for identifying patients with organic gastrointestinal disease: systematic review and meta‐analysis

“…By excluding organic GID, findings of non‐elevated FC levels also enable early and reliable diagnosis of a functional GID by general practitioners without gastroenterology referral or further testing. Confident diagnosis of a functional GID in primary care is likely to improve patient acceptance of their diagnosis and their uptake of effective management …”

“…Confident diagnosis of a functional GID in primary care is likely to improve patient acceptance of their diagnosis and their uptake of effective management. 5 Accurate diagnosis of a functional GID reduces the number of referrals for more expensive and invasive investigations, including colonoscopy. An audit of colonoscopies in an Australian hospital found that 12% were for patients with functional gastrointestinal symptoms; further, 79% of patients seen in a public hospital who were diagnosed with a functional GID had undergone an endoscopic procedure, at an overall cost (including indirect costs) of $187 million, with an additional $2.4 million per year in emergency department presentations and hospital admissions.…”

“…Functional GIDs are much more frequent than organic GIDs; the most common functional GID, irritable bowel syndrome (IBS), affects about 10–20% of the population, with onset between 20 and 40 years of age . Once a functional GID has been diagnosed, further diagnostic tests are not required and patients can be managed in primary care . In contrast, several organic GIDs result in inflammation of the colon, and patients with these conditions are best assessed by specialists, often with colonoscopy or cross‐sectional imaging.…”

“…3,4 Once a functional GID has been diagnosed, further diagnostic tests are not required and patients can be managed in primary care. 5 In contrast, several organic GIDs result in inflammation of the colon, and patients with these conditions are best assessed by specialists, often with colonoscopy or cross-sectional imaging. In young adults (20-40 years of age) the most common organic GID is IBD (including ulcerative colitis and Crohn disease), which affects 0.4% of people under 50 years of age.…”

“…4 South Western Sydney Clinical School, University of New South Wales, Sydney, NSW. 5 Royal Flying Doctor Service, Canberra, ACT. 6 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT.…”