GP perspectives of irritable bowel syndrome – an accepted illness, but management deviates from guidelines: a qualitative study

Harkness, Elaine; Harrington, Val; Hinder, Susan; O’Brien, Sarah J.; Thompson, David G.; Beech, Paula; Chew‐Graham, Carolyn

doi:10.1186/1471-2296-14-92

Cited by 31 publications

(34 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Findings from our qualitative study suggest GPs did not describe difficulties in managing patients with IBS [6]. This is also evident in the current study where a relatively small proportion of patients with IBS had a referral to a GI specialist, compared to those patients with a diagnosis of IBD.…”

Section: Discussionsupporting

confidence: 65%

Using read codes to identify patients with irritable bowel syndrome in general practice: a database study

et al. 2013

Self Cite

View full text Add to dashboard Cite

BackgroundEstimates of the prevalence of irritable bowel syndrome (IBS) vary widely, and a large proportion of patients report having consulted their general practitioner (GP). In patients with new onset gastrointestinal symptoms in primary care it might be possible to predict those at risk of persistent symptoms. However, one of the difficulties is identifying patients within primary care. GPs use a variety of Read Codes to describe patients presenting with IBS. Furthermore, in a qualitative study, exploring GPs’ attitudes and approaches to defining patients with IBS, GPs appeared reluctant to add the IBS Read Code to the patient record until more serious conditions were ruled out. Consequently, symptom codes such as 'abdominal pain’, 'diarrhoea’ or 'constipation’ are used. The aim of the current study was to investigate the prevalence of recorded consultations for IBS and to explore the symptom profile of patients with IBS using data from the Salford Integrated Record (SIR).MethodsThis was a database study using the SIR, a local patient sharing record system integrating primary, community and secondary care information. Records were obtained for a cohort of patients with gastrointestinal disorders from January 2002 to December 2011. Prevalence rates, symptom recording, medication prescribing and referral patterns were compared for three patient groups (IBS, abdominal pain (AP) and Inflammatory Bowel Disease (IBD)).ResultsThe prevalence of IBS (age standardised rate: 616 per year per 100,000 population) was much lower than expected compared with that reported in the literature. The majority of patients (69%) had no gastrointestinal symptoms recorded in the year prior to their IBS. However a proportion of these (22%) were likely to have been prescribed NICE guideline recommended medications for IBS in that year. The findings for AP and IBD were similar.ConclusionsUsing Read Codes to identify patients with IBS may lead to a large underestimate of the community prevalence. The IBS diagnostic Read Code was rarely applied in practice. There are similarities with many other medically unexplained symptoms which are typically difficult to diagnose in clinical practice.

show abstract

Section: Discussionsupporting

confidence: 65%

Using read codes to identify patients with irritable bowel syndrome in general practice: a database study

et al. 2013

Self Cite

View full text Add to dashboard Cite

show abstract

“…12 This is also supported by the reluctance of PHCPs to add IBS read-codes to patient records until more serious pathology was excluded. 31 Although FGIDs are largely managed in primary care, this study together with the specialist FGID referral load suggests that the real-world confidence of clinicians in diagnosing FGIDs and communicating in some instances is low.…”

Section: Discussionmentioning

confidence: 88%

“…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 . This is also supported by the reluctance of PHCPs to add IBS read‐codes to patient records until more serious pathology was excluded . Although FGIDs are largely managed in primary care, this study together with the specialist FGID referral load suggests that the real‐world confidence of clinicians in diagnosing FGIDs and communicating in some instances is low.…”

Section: Discussionmentioning

confidence: 93%

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

et al. 2017

View full text Add to dashboard Cite

Background and AimTo investigate the quality of and reasons for referrals of patients with likely functional gastrointestinal disorders (FGID) and explore patients’ experience of clinical management.MethodsA cross sectional, mixed‐methods study was undertaken. Referrals (July 2013–2015) to one gastroenterology outpatient department triaged as “likely FGID”, the referred patients and their referring primary healthcare providers were examined.ResultsA total of 69% of patients reported not yet receiving an initial diagnosis, 52% reported persistent/distressing symptoms or reduced quality of life, 24% feared missed or worsening pathology, and 35% were seeking repeat specialist consultation. Most patients were dissatisfied (40%) or only partially satisfied (36%) with current management. Dissatisfaction was significantly related to the lack of provision of a diagnosis and effective treatment options (P < 0.001). Referral quality was poor and with the reason for referral clearly communicated in only 25%. Common referral reasons included repeat presentations (n = 32), diagnostic uncertainty (n = 19), to ensure nothing is missed (n = 19), patient request (n = 17), no response to treatment (n = 16), and to allay patient fears (n = 14). A total of 28/60 primary healthcare providers were confident that their patient had a FGID, yet sought confirmation (n = 16), second opinion (n = 8), or advice (n = 4).ConclusionCurrent management of FGID in usual care is suboptimal, as evidenced by the tertiary referral load, patient dissatisfaction, and the lack of provision of diagnoses and effective treatment options. Some clinicians lack confidence in effectively identifying and managing these conditions. Resources and supports to equip and assist clinicians to identify and manage FGID successfully may enhance patient care.

show abstract

“…Although clinical trial data support that the reduction of FODMAPs is beneficial for patients with IBS [52,54,57], long-term adherence to a strict low FODMAP diet is not recommended because of nutritional concerns and potential effects on the gut microbiota [58]; rather, excluded components of the diet should be slowly reintroduced until satisfactory symptom control is maintained by the individual patient [59]. Interestingly, a study conducted in England reported that primary care physicians (PCPs) generally recommend dietary modification first to patients with IBS [60], but based on the very low quality of evidence, the American College of Gastroenterology (ACG) makes only a weak recommendation for specialized diets in the management of IBS [1].…”

Section: Low Fodmap Dietmentioning

confidence: 99%

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Harris

Baffy

2017

Postgraduate Medicine

View full text Add to dashboard Cite

Irritable bowel syndrome (IBS), which is characterized by recurrent abdominal pain and disordered bowel habits, is one of the most common functional bowel disorders. IBS is a substantial burden on both patient health-related quality of life and healthcare costs. Several pathophysiologic mechanisms have been postulated for the occurrence of IBS, including altered gastrointestinal motility, visceral hypersensitivity, changes in gut permeability, immune activation, gut-brain dysregulation, central nervous system dysfunction, and changes in the gut microbiota. Of note, both qualitative and quantitative differences have been observed in the gut microbiota of a population with IBS versus a healthy population. Because of the substantial interest in the gut microbiota and its role as a therapeutic target in IBS, this article provides an overview of specific interventions with the potential to modulate the gut microbiota in IBS, including elimination diets, prebiotics, probiotics, synbiotics, and nonsystemic antibiotics. Although probiotics and synbiotics are generally well tolerated, differences in the composition and concentration of different bacterial species and inclusion or exclusion of prebiotic components varies widely across studies and has prevented strong recommendations on their use in IBS. For nonsystemic antibiotics, rifaximin is indicated in the United States for the treatment of IBS with diarrhea in adults and has been shown to be efficacious and well tolerated in well-designed clinical trials. Overall, more consistent evidence is needed regarding the efficacy and safety of elimination diets, prebiotics, probiotics, and synbiotics for the treatment of patients with IBS. Furthermore, additional well-designed studies are needed that examine alterations in the gut microbiota that occur with these interventions and their potential associations with clinical symptoms of IBS. ARTICLE HISTORY

show abstract

GP perspectives of irritable bowel syndrome – an accepted illness, but management deviates from guidelines: a qualitative study

Cited by 31 publications

References 31 publications

Using read codes to identify patients with irritable bowel syndrome in general practice: a database study

Using read codes to identify patients with irritable bowel syndrome in general practice: a database study

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

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Contact Info

Product

Resources

About