Diagnosing and managing irritable bowel syndrome with predominant diarrhoea in clinical practice: online survey among gastroenterologists and general practitioners.

IF 1.3 4区医学 Q4 GASTROENTEROLOGY & HEPATOLOGY

Acta gastro-enterologica Belgica Pub Date : 2024-04-01 DOI:10.51821/87.2.12586

Ph Casteels, S Kindt

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引用次数: 0

Abstract

Introduction: Irritable bowel syndrome (IBS) represents the most common disorder of gut-brain interaction encountered in clinical practice. The Rome IV criteria define the disorder. Over the years, many guidelines proposed guidance during the diagnostic and therapeutic approach of patients with presumed IBS.

Aim: This study investigates the management of IBS with predominant diarrhoea (IBS-D) by Belgian gastroenterologists (GE) and general practitioners (GP) in daily practice.

Methods: An online vignette-based survey was conducted exploring the diagnostic and therapeutic approach of patients suffering from IBS with predominant diarrhoea (IBS-D) in primary and secondary care.

Results: 64 GE and 31 GP completed the survey. Abdominal pain and discomfort led to an IBS diagnosis in 88% and 84% of cases, respectively. The diagnosis rate dropped to 58.3% with diarrhoea as main presentation and 26.8% for patients aged 65. Additional tests were ordered by 89.5% of physicians, including biochemistry (77.9%), stool culture and parasites (59.3%), iFOBT (60.5%), breath testing (17.4%), imaging (12.8%), and endoscopy (9.3%). Upon normal results, 57% of physicians did not order further investigations. Both GP and GE preferred spasmolytics (64.3%) and dietary interventions (23.9%) as first-line treatment for IBS. Second-line treatment options included referral to a specialist or colleague (19.4%), dietary intervention (22.6%), neuromodulators (19.4%), and spasmolytics (14.5%). No GP initiated neuromodulators.

Conclusion: In Belgium, abdominal pain or discomfort are equivalent cardinal symptoms when diagnosing IBS. During the further diagnostic and therapeutic approach most physicians order only limited additional non-invasive testing. Spasmolytics and dietary interventions are favoured in first-line. Upon failure, only GE prescribe neuromodulators, while GP opt for referral. These findings are consistent with the general principles and recommendations outlined in the recently published Belgian guideline for IBS.

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在临床实践中诊断和处理以腹泻为主的肠易激综合征：对消化内科医生和全科医生的在线调查。

简介：肠易激综合征（IBS肠易激综合征（IBS）是临床上最常见的肠脑交互障碍。罗马IV标准界定了这种疾病。目的：本研究调查了比利时消化内科医生（GE）和全科医生（GP）在日常工作中对以腹泻为主的肠易激综合征（IBS-D）的处理情况：结果：64 名消化内科医生和 31 名全科医生完成了调查：64 名普通医生和 31 名全科医生完成了调查。分别有 88% 和 84% 的病例因腹痛和不适而被诊断为肠易激综合征。以腹泻为主要表现的诊断率降至 58.3%，65 岁患者的诊断率为 26.8%。89.5%的医生要求进行其他检查，包括生化检查（77.9%）、粪便培养和寄生虫检查（59.3%）、iFOBT（60.5%）、呼气试验（17.4%）、影像学检查（12.8%）和内窥镜检查（9.3%）。在检查结果正常的情况下，57% 的医生没有要求进行进一步检查。全科医生和普通医生都倾向于将解痉剂（64.3%）和饮食干预（23.9%）作为肠易激综合征的一线治疗方法。二线治疗方案包括转诊至专科医生或同事（19.4%）、饮食干预（22.6%）、神经调节剂（19.4%）和解痉剂（14.5%）。没有全科医生使用神经调节剂：结论：在比利时，腹痛或腹部不适是诊断肠易激综合征的主要症状。结论：在比利时，诊断肠易激综合征时，腹痛或腹部不适是相同的主要症状。在进一步的诊断和治疗过程中，大多数医生只要求进行有限的额外非侵入性检查。解痉剂和饮食干预是首选的一线治疗方法。如果治疗失败，只有 GE 会开具神经调节剂，而全科医生则会选择转诊。这些发现与最近出版的比利时肠易激综合征指南中概述的一般原则和建议一致。

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来源期刊

Acta gastro-enterologica Belgica Medicine-Gastroenterology

CiteScore

2.30

自引率

20.00%

发文量

期刊介绍： The Journal Acta Gastro-Enterologica Belgica principally publishes peer-reviewed original manuscripts, reviews, letters to editors, book reviews and guidelines in the field of clinical Gastroenterology and Hepatology, including digestive oncology, digestive pathology, as well as nutrition. Pure animal or in vitro work will not be considered for publication in the Journal. Translational research papers (including sections of animal or in vitro work) are considered by the Journal if they have a clear relationship to or relevance for clinical hepato-gastroenterology (screening, disease mechanisms and/or new therapies). Case reports and clinical images will be accepted if they represent an important contribution to the description, the pathogenesis or the treatment of a specific gastroenterology or liver problem. The language of the Journal is English. Papers from any country will be considered for publication. Manuscripts submitted to the Journal should not have been published previously (in English or any other language), nor should they be under consideration for publication elsewhere. Unsolicited papers are peer-reviewed before it is decided whether they should be accepted, rejected, or returned for revision. Manuscripts that do not meet the presentation criteria (as indicated below) will be returned to the authors. Papers that go too far beyond the scope of the journal will be also returned to the authors by the editorial board generally within 2 weeks. The Journal reserves the right to edit the language of papers accepted for publication for clarity and correctness, and to make formal changes to ensure compliance with AGEB’s style. Authors have the opportunity to review such changes in the proofs.