 |
|
Evidence- and Consensus-Based Practice Guidelines for the Diagnosis of Irritable Bowel Syndrome
Ronnie Fass, MD;
George F. Longstreth, MD;
Mark Pimentel, MD;
Steven Fullerton, MPH;
Simcha M. Russak, MA;
Chiun-Fang Chiou, PhD;
Eileen Reyes, BS;
Paul Crane, MD;
Glenn Eisen, MD;
Bill McCarberg, MD;
Joshua Ofman, MD, MSHS
Arch Intern Med. 2001;161:2081-2088.
Background Irritable bowel syndrome (IBS) presents a significant diagnostic and
management challenge for primary care practitioners. Improving the accuracy
and timeliness of diagnosis may result in improved quality and efficiency
of care.
Objective To systematically appraise the existing diagnostic criteria and combine
the evidence with expert opinion to derive evidence- and consensus-based guidelines
for a diagnostic approach to patients with suspected IBS.
Methods We performed a systematic literature review (January 1966–April
2000) of computerized bibliographic databases. Articles meeting explicit inclusion
criteria for diagnostic studies in IBS were subjected to critical appraisal,
which formed the basis of guideline statements presented to an expert panel.
To develop a diagnostic algorithm, an expert panel of specialists and primary
care physicians was used to fill in gaps in the literature. Consensus was
developed using a modified Delphi technique.
Results The systematic literature review identified only 13 published studies
regarding the effectiveness of competing diagnostic approaches for IBS, the
accuracy of diagnostic tests, and the internal validity of current diagnostic
symptom criteria. Few studies met accepted methodological criteria. While
symptom criteria have been validated, the utility of endoscopic and other
diagnostic interventions remains unknown. An analysis of the literature, combined
with consensus from experienced clinicians, resulted in the development of
a diagnostic algorithm relevant to primary care that emphasizes a symptom-based
diagnostic approach, refers patients with alarm symptoms to subspecialists,
and reserves radiographic, endoscopic, and other tests for referral cases.
The resulting algorithm highlights the reliance on symptom criteria and comprises
a primary module, 3 submodules based on the predominant symptom pattern (constipation,
diarrhea, and pain) and severity level, and a subspecialist referral module.
Conclusions The dearth of available evidence highlights the need for more rigorous
scientific validation to identify the most accurate methods of diagnosing
IBS. Until such time, the diagnostic algorithm presented herein could inform
decision making for a range of providers caring for primary care patients
with abdominal discomfort or pain and altered bowel function suggestive of
IBS.
From the Department of Medicine, Southern Arizona Veterans Affairs
Medical Center, Tucson (Dr Fass); Department of Medicine, Kaiser Permanente
Medical Care Program, San Diego, Calif (Drs Longstreth, Crane, and McCarberg);
Departments of Medicine (Drs Pimentel and Ofman) and Health Services Reseach
(Dr Ofman), Cedars-Sinai Health System, Los Angeles, Calif; Zynx Health Inc,
Los Angeles (Messrs Fullerton and Russak, Drs Chiou and Ofman, and Ms Reyes);
and Department of Medicine, Vanderbilt University Medical Center, Nashville,
Tenn (Dr Eisen).
RELATED ARTICLE
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2001;161(17):2155-2156.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
GPs' explanatory models for irritable bowel syndrome: a mismatch with patient models?
Casiday et al.
Fam Pract 2008;0:cmn088v1-cmn088.
ABSTRACT
| FULL TEXT
The Central Role of Gastrointestinal-Specific Anxiety in Irritable Bowel Syndrome: Further Validation of the Visceral Sensitivity Index
Labus et al.
Psychosom. Med. 2007;69:89-98.
ABSTRACT
| FULL TEXT
Diagnostic yield of alarm features in irritable bowel syndrome and functional dyspepsia
Hammer et al.
Gut 2004;53:666-672.
ABSTRACT
| FULL TEXT
Irritable Bowel Syndrome: New Recommendations for Diagnosis and Treatment
Lacy
Arch Intern Med 2003;163:1374-1375.
FULL TEXT
|
