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Volume 3, Supplement 3, 2003

Volume 3, Supplement 3, 2003

Table of Contents

The Challenge of Diagnosing Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) has not been associated with any pathopneumonic structural, biochemical, or serologic abnormalities. In addition, the symptoms associated with IBS mimic those of many other diseases. Physicians, therefore, face a challenge when presented with a patient who has symptoms consistent with IBS. The physician must be able to correctly identify patients who truly have the disorder, while excluding patients for whom symptoms are related to a non-IBS cause. Standard diagnostic criteria, such as the Manning and Rome criteria, greatly facilitate the appropriate diagnosis and treatment of IBS. [Rev Gastroenterol Disord. 2003;3(suppl 3):S3-S11]
Natural History of Irritable Bowel Syndrome and Durability of the Diagnosis
Each year, approximately 10% of the general population experience symptoms consistent with irritable bowel syndrome (IBS); only about half of these persons will seek care for their symptoms. This review discusses the natural history of IBS from 2 perspectives: a population-based perspective and a clinical perspective. Persons with IBS symptoms often have multiple symptoms that change over time. In addition, patients who receive a diagnosis of IBS rarely develop an organic disease to explain their symptoms. The diagnosis of IBS, when made properly, is a reliable diagnosis. Unfortunately, therapeutic options are limited; thus, the natural history of IBS is one in which symptoms appear, disappear, and change over time. [Rev Gastroenterol Disord. 2003;3(suppl 3):S12-S17]
When to Conduct Testing in Patients With Suspected Irritable Bowel Syndrome
Patients who have abdominal discomfort or pain plus disturbed defecation warrant a careful history taking and physical examination. The presence of positive symptom criteria for irritable bowel syndrome (IBS) usually correctly identifies the underlying IBS diagnosis. The clinical evaluation may uncover findings that cause concern about underlying organic disease (“alarm features" or “red flags"). Traditional alarm features include bleeding, obvious anemia, weight loss, and older age at onset. Although the diagnostic utility of most of these red flags has not been tested, patients with these symptoms should be investigated promptly. In the primary care setting, most patients who have alarm symptoms will have a negative further evaluation, and the original IBS diagnosis will be confirmed. In the past, numerous tests (eg, complete blood cell count, flexible sigmoidoscopy) were considered routine for patients with suspected IBS in the primary care setting. However, available data do not support this approach; these patients do not have an increased likelihood of most organic diseases compared with control populations without IBS. Although celiac disease may occur more frequently in persons with IBS, the yield of serologic testing is likely to be low. Testing is generally not required in patients with positive symptom criteria for IBS and an absence of alarm features. [Rev Gastroenterol Disord. 2003;3(suppl 3):S18–S24]
Legal Risks in Treating Irritable Bowel Syndrome
Physicians who treat irritable bowel syndrome (IBS) reasonably seek strategies to reduce the risk of malpractice. They are concerned that, in the absence of laboratory or radiographic markers specific for the disorder, what appears to be a reasonable diagnosis of IBS could lead to a malpractice claim if an alternate diagnosis is later discovered. Physicians need to understand the sources of malpractice risk, and risk management strategies related to these sources, to reduce their exposure to liability suits in this area. This article outlines these sources of risk, or conditions under which physicians may be sued, known as torts. The tort of negligence is covered, including its 4 elements: the duty to provide care to a patient, medical practice below the standard of care, the resultant harm, and the establishment of compensable damages. The concepts of informed consent and vicarious liability are also presented. This discussion is developed within the context of a risk management approach, to assist physicians in developing a preventative approach to malpractice liability when considering the diagnosis of IBS. [Rev Gastroenterol Disord. 2003;3(suppl 3):S25-S31]
Irritable Bowel Syndrome: A Primer on Management
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain, bloating, and either constipation or diarrhea. Managing this chronic condition requires a coordinated effort between patient and physician. The diagnosis of IBS should be made as early as possible in the evaluation of a patient, so that treatment can be initiated as soon as possible. Treatment usually requires a multifactorial approach, including patient education, reassurance, lifestyle changes, and pharmacotherapy. In this article, medications commonly used to treat the individual symptoms of IBS are reviewed, based on evidence from the literature. In addition, new agents that affect the serotonin system and treat the global symptoms of IBS are described. [Rev Gastroenterol Disord. 2003;3(suppl 3):S32-S42]