Patients with irritable bowel syndrome IBS in general practice

1
Patients with irritable bowel syndrome (IBS) in
general practice

• Luise Mølenberg Begtrup
• The Departement of Gastroenterology, Odense
  University Hospital
• and
• Research Unit of General Practice, Institute of
  Public Health
• University of Southern Denmark

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How do we distinguish between the majority of
people suffering from IBS and the minority of
people suffering from organic disease

• Colorectal cancer
• Inflammatory bowel
• disease
• Celiac sprue
• Lactose intolerance

IBS - patients
Wheres Wally
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Diagnosis of a condition with no objective
findings

• Diagnosis of exclusion

• Positive diagnosis

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• CRITERIA for DIAGNOSIS OF IBS
• Recurrent abdominal pain or discomfort
• associated with two or more of the following
• Improvement with defecation
• Onset associated with change in frequency of
  stool
• Onset associated with change in form (appearance)
  of stool
• Duration more than 3 months, onset more than 6
  month ago. Frequency of symptoms at least 3 days
  / month
• Rome III critea (2006)

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• A Positive diagnosis.
• IBS criteria fulfilled
• Age lt 50 years
• Alarm features
• Physical examination
• FBC, CRP, (screening for celiac sprue)
• NICE-guidelines 2008, AGA 2002, Clinical Services
  Committee of The British society of
  Gatroenterology 2007

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• Diagnosis of exclusion

• Positive diagnosis

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• Diagnosis of exclusion

• Positive diagnosis

• Diagnostic criteria no alarm features has a
• positive predictive value 98-100
• Vanner SJ, et al. AJG 1999
• Pretest probability for organic disease lt 1
• in patients meeting the criteria
• Cash et al. AJG 2002
• 1 1000 ? perforation of the intestine
• 1 10.000 dies
• when having diagnostic colonoscopy
• Anderson ML et. al. AJG 2000

• Symptoms mimic symptoms of CRC
• and IBD
• The one young patient with cancer despite no
  alarm features
• Reassurance
• Patients wish / demand

repeated testing suggests an unconfident doctor
or a patient with persistent fears of organic
disease, perhaps one fostering the
other Thompsom et al. GUT 2002
8

• If we suspect Irritabel bowel syndrome (IBS),
  only few investigations may be necessary.
• We cannot cure the IBS patients,
• but we can help them.

9
IBS patient return visits compared
with Phycisian-patient interaction
Owens, D. M. et. al. Ann Intern Med
1995122107-112
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• Phycisian-patient interaction
• Psychosocial history
• Precipitating factors
• Involving the patient in the discussion of
  diagnosis and treatment
• Owens, D. M. et. al. Ann Intern Med
  1995122107-112

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PROBIOTICS
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• If we suspect irritabel bowel syndrome (IBS),
  only few investigations may be necessary.
• We cannot cure the IBS patients,
• but we can help them.