Do patients with irritable bowel syndrome in primary care really differ from outpatients with irritable bowel syndrome?

Horst, Henriëtte E. van der; Dulmen, A.M. van; Schellevis, F.G.; Eijk, J.T.M. van; Fennis, J.F.M.; Bleijenberg, Gijs

doi:10.1136/gut.41.5.669

Cited by 67 publications

(46 citation statements)

References 26 publications

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“…27,28 A current problem with hypnotherapy and CBT is their limited availability, and that few GPs would consider referral to such treatment. 29,30 Our findings suggest, in contrast to what has been reported in referred patients, 31 that such intervention will be welcomed by patients with IBS and excessive comorbidity, since the majority related their abdominal complaints to stress and psychological factors. Patients with IBS and few or no other bodily symptoms (low comorbidity) were characterized by apparently normal psychological profiles, HRQoL, adverse life events and ability to work.…”

Section: Discussioncontrasting

confidence: 54%

Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications

Vandvik

Wilhelmsen

Ihlebæk

et al. 2004

Aliment Pharmacol Ther

142

101

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Summary Background : Somatic comorbid symptoms might identify irritable bowel syndrome patients with different aetiologies and needs of treatment. Aims : To measure comorbid symptoms in patients with irritable bowel syndrome in general practice, and to explore characteristics of patients with low, intermediate and high somatic comorbidity. Methods : Prospective study of 208 of 278 consecutive patients with irritable bowel syndrome (Rome II) in nine general practices. Questionnaires assessed 22 comorbid symptoms (subjective health complaint inventory), psychosocial factors including psychological distress (Symptom Check list‐10) and quality of life (Short form‐12). Subjective health complaint data from 1240 adults (controls) constituted a reference material. Patients with low, intermediate and high somatic comorbidity were identified by a somatic comorbidity score (17 subjective health complaint items). Health care seeking was assessed after 6–9 months. Results : Patients with irritable bowel syndrome (67% females, mean age 50, s.d. 16) reported 20 of 22 comorbid symptoms significantly more frequent than controls (odds ratios = 2–7, P < 0.001). The somatic comorbidity score correlated with psychological distress (R = 0.46, P < 0.001). Patients with high somatic comorbidity reported higher levels of mood disorder, health anxiety, neuroticism, adverse life events and reduced quality of life and increased health care seeking when compared to those with low and intermediate somatic comorbidity (P‐values < 0.05). Conclusions : Our findings support the hypothesis that structured assessment of comorbid somatic symptoms might identify subgroups with different aetiology and needs of treatment.

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Section: Discussioncontrasting

confidence: 54%

Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications

Vandvik

Wilhelmsen

Ihlebæk

et al. 2004

Aliment Pharmacol Ther

142

101

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“…13 Patients referred to secondary care have greater symptom severity than those retained in primary care and also attribute their symptoms less to stress than do primary care patients. 76 This is in keeping with the findings of a prospective study conducted in UK primary care where referral to a specialist could be predicted by the patient's denial of a role of stress, undergoing multiple testing in primary care and reporting frequent bowel movements. 77 Many of the patients seen in general practice feared that they had cancer and the authors reported that multiple testing may have prolonged their anxiety, citing a paper that emphasises the double-edged nature of normal tests.…”

Section: Introductionsupporting

confidence: 52%

Cognitive behavioural therapy in addition to antispasmodic therapy for irritable bowel syndrome in primary care: randomised controlled trial

Kennedy¹,

Chalder²,

McCrone³

et al. 2006

Health Technol Assess

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“…22 Physiological factors Altered somatovisceral sensitivity and motor dysfunction of the intestine are thought to be possible pathophysiological mechanisms involved in 23 24 altered afferent processing, and altered pain threshold to gut distension 25 26 have all been implicated. However, studies are conflicting with problems of reproducibility probably related to patient selection, sedation, and methodological differences.…”

Section: Psychological Factorsmentioning

confidence: 99%

Management of irritable bowel syndrome

Gunn

Cavin

Mansfield

2003

Postgraduate Medical Journal

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The diagnosis of irritable bowel syndrome (IBS) is made on clinical grounds with appropriate limited investigations to exclude organic disease. IBS is common and may have a significant impact on a patient’s quality of life. Psychological symptoms are common. IBS may benefit from pharmacological and non-pharmacological management. Specific measures should be directed towards the dominant symptoms of constipation or diarrhoea. Several new drugs are currently under evaluation and may prove valuable for subgroups of patients with IBS. Successful management requires a combination of reassurance and explanation about the natural history of the condition.

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Do patients with irritable bowel syndrome in primary care really differ from outpatients with irritable bowel syndrome?

Cited by 67 publications

References 26 publications

Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications

Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications

Cognitive behavioural therapy in addition to antispasmodic therapy for irritable bowel syndrome in primary care: randomised controlled trial

Management of irritable bowel syndrome

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