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Do physicians follow evidence-based guidelines in the diagnostic work-up of IBS?

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 296–297 (2007)Cite this article

IBS is a chronic disorder of gastrointestinal function that is characterized by recurrent abdominal pain and altered bowel habits in the absence of detectable organic disease. Although IBS is extremely prevalent, affecting up to 15% of the general adult population,1 its diagnosis is not always straightforward for several reasons: IBS has no consistent biological marker, which leaves clinicians to rely on patient symptoms alone to make the diagnosis; the symptoms of IBS are often difficult to quantify objectively; and many organic conditions can masquerade as IBS. The last fact is the most troubling to both clinicians and patients, many of whom are unsettled by the prospect that alternative diagnoses have been overlooked (such as IBD, microscopic colitis, infectious colitis, small intestinal bacterial overgrowth, celiac sprue, and colon neoplasia, among many others). This uncertainty often prompts clinicians to approach IBS as a diagnosis of exclusion, by performing tests to exclude alternative etiologies.

Conversely, the Rome III criteria encourage clinicians to make a positive diagnosis of IBS on the basis of validated symptom criteria, and emphasize that IBS is not a diagnosis of exclusion.1 This recommendation is based on extensive evidence2 that diagnostic tests generally have a very low yield in patients who fulfil the Rome criteria but who otherwise lack alarm signs or symptoms. Vanner et al. demonstrated that Rome-criteria symptoms have a positive predictive value of 98% for diagnosing IBS.3 In other words, 98% of patients with Rome-criteria symptoms have IBS, rather than an underlying organic condition, after undergoing standard evaluations.

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Author notes

  1. Division of Gastroenterology and Hepatology, Veterans Affairs Greater Los Angeles Healthcare System, Room 215, Building 115, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA bspiegel@mednet.ucla.edu

Authors and Affiliations

  1. BMR Spiegel is an Assistant Professor of Medicine at the Veterans Affairs Greater Los Angeles Healthcare System and Director of the University of California, Los Angeles/Veterans Affairs Center for Outcomes Research and Education (CORE), Los Angeles, CA, USA.,

    Brennan MR Spiegel

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Spiegel, B. Do physicians follow evidence-based guidelines in the diagnostic work-up of IBS?. Nat Rev Gastroenterol Hepatol 4, 296–297 (2007). https://doi.org/10.1038/ncpgasthep0820

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