Stability of irritable bowel syndrome using a Rome II‐based classification

Williams, RE; Black, C; Kim, H.-Y.; Andrews, Elizabeth; Mangel, Allen W.; Buda, Jeffrey J; Cook, SF

doi:10.1111/j.1365-2036.2006.02723.x

Cited by 31 publications

(20 citation statements)

References 20 publications

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“…However, examination of sex distribution suggests a possible trend toward a higher prevalence of IBS-C in girls compared with boys and a higher prevalence of IBS-D in boys versus girls. This is a cautious interpretation that warrants replication, but such findings would be consistent with most of the adult literature on sex differences in IBS 10,11,13,25-27 , as well as the pediatric study by Rajindrajtih & Devanarayana, reporting females as more likely than males to be subtyped as IBS-C. 15 …”

Section: Discussionsupporting

confidence: 83%

“…Adult research has questioned the stability of IBS subtype classification. 8-10,12, 25-27, 31,32 Examining subtype stability in developing children presents an additional challenge but is an important area for future research. On the other hand, strengths of our study include the use of prospective diaries, the inclusion of primary and tertiary care patients, and evaluation by their physician to prevent inclusion of children with organic disease.…”

Section: Discussionmentioning

confidence: 99%

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Subtypes of Irritable Bowel Syndrome in Children and Adolescents

Self

Czyzewski

Chumpitazi

et al. 2014

Clinical Gastroenterology and Hepatology

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Background & Aims Pharmacologic treatments for IBS and medical management of symptoms are increasingly based on IBS subtype, so it is important to accurately differentiate patients. Few studies have classified subtypes of pediatric IBS, and conclusions have been challenged by methodologic limitations. We performed a prospective study to investigate the distribution of IBS subtypes among children and adolescents based on stool diary information, and compared subtypes according to demographic and pain characteristics. Methods We studied 129 subjects, 7–18 y old (mean 11.4 ± 2.8 y old, 60.5% female, 69.0% Caucasian) who met Pediatric Rome III IBS criteria and were part of larger studies of children with functional gastrointestinal disorders, recruited from primary and tertiary care centers. Children completed daily pain and stool diaries for 2 weeks. Participants were assigned IBS subtypes based on their reported stool information, per adult Rome III criteria. IBS subtypes were compared for demographic variables and pain characteristics. Results IBS with constipation (IBC-C) was the most common subtype of the disorder (58.1% of subjects), whereas mixed IBS (IBS-M) was the least common (2.3% of subjects); 34.1% of subjects were unsubtyped (IBS-U) and 5.4% had IBS with diarrhea (IBS-D). The groups of different IBS subtypes did not differ significantly by sex, age, ethnicity, or pain characteristics. Conclusions In contrast to adults, IBS-C and IBS-U are the most common subtypes of IBS in children, whereas IBS-D and IBS-M are less common. Demographic and pain characteristics cannot distinguish subtypes.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Subtypes of Irritable Bowel Syndrome in Children and Adolescents

Self

Czyzewski

Chumpitazi

et al. 2014

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

show abstract

“…However, although most GPs in our study were aware of the guideline, which recommends making a positive diagnosis considering the presence of symptoms, most described an iterative approach to diagnosis with emphasis on exclusion of ‘red flag’ symptoms and described concern about missing something more serious. Thus GPs were reluctant to apply a label of IBS to patients and Read codes were reported as only being applied if the patient re-consults (which they often do not, [6,16]) perhaps explaining differences in prevalence rates of IBS in the literature [27,28], and probably reflecting the fluctuating nature of the condition [29]. This approach has implications for the management of other MUS, particularly those which are less acceptable, for example Chronic Pelvic Pain (CPP) [21], and for GP training about these conditions.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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BackgroundThe estimated prevalence of irritable bowel syndrome (IBS) is 10%. Up to one third of patients develop chronic symptoms, which impact on everyday functioning and psychological wellbeing. Guidelines suggest an increased role for primary care in the management of patients with IBS, and referral for psychological interventions. Literature reports dissatisfaction and frustration experienced by both patients with IBS and healthcare professionals. The aim of this study was to explore the perspectives of general practitioners (GPs) in relation to the diagnosis and management of IBS and their views on the potential use of a risk assessment tool to aid management decisions for patients with IBS in primary care.MethodsThis was a qualitative study using face-to-face semi-structured interviews with GPs in North West England. Interviews were fully transcribed and data analyzed using constant comparison across interviews. Tensions between GP accounts and the NICE guideline for the management of IBS were highlighted.ResultsGPs described IBS as a diagnosis of exclusion and the process as tentative and iterative, with delay in adding a Read code to the patient record until they were confident of the diagnosis. Whilst GPs accepted there was a link between IBS and psychological symptoms they suggested that the majority of patients could be managed within primary care without referral for psychological interventions, in conflict with the NICE guideline. They did not feel that a risk assessment tool for patients with IBS would be helpful.ConclusionsThis study highlights the tensions between evidence recognizing the need to identify patients whose symptoms may become chronic and offer pro-active care, including referral for psychological therapies, and the perspectives of GPs managing patients in every-day clinical practice. The reluctance of GPs to refer patients for evidence-based psychological treatments may have implications for commissioning services and patient care.

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“…Upon enrollment into the panel, individuals without Internet access are provided with free Web-TV and Internet service. Thus, rather than being a convenience sample of Internet users, the KN panel is a reasonably representative sample of the US population and has been used in published studies in Journal of the American Medical Association, Menopause, and Alimentary Pharmacology and Therapeutics [9][10][11][12][13][14] .…”

Section: Study Populationmentioning

confidence: 99%