![]() The data used in this study were obtained from the AXON Database. The objective of this study was to calculate primary-care prescribing and both hospital outpatient and admission costs associated with the management of IBS in England. It can be concluded from the literature that the burden of IBS on services is high. ![]() In a systematic review of data from the USA and the UK for 1990–2004, mean work loss attributed to IBS ranged from 8.5 to 21.6 days per year. 14 Indirect costs through lost work productivity have also been documented. 4 Another study found that 40% of patients with IBS had visited their physician at least once for their symptoms in the past 3 months, and 12% had visited their physician several times. ![]() Hungin and colleagues showed that 7% of European patients with IBS were hospitalised for their condition over a period of 12 months, and 5% had been hospitalised more than once. In addition, several studies have quantified the burden of IBS on healthcare resources. Impairments in health status for those with IBS have been well documented. However, poor clinical coding, with no specific codes for the various subtypes of IBS, makes accurate assessment of this burden challenging. 13Ĭlearly the burden of IBS is high in terms of consultations in both primary and secondary care, and the impact on endoscopy services and prescribing costs. 12 Patients with IBS-C identified in primary care rarely have this diagnosis changed following referral and investigation in secondary care. Even once a diagnosis of IBS is made in primary care, despite current guidelines, around half of these patients are referred for endoscopic evaluation. The main reasons for this are diagnostic uncertainty and the persistence of symptoms. However, a significant proportion of those patients who are diagnosed are still referred to secondary care. ![]() 10īoth National Institute of Health and Care Excellence (NICE) 11 and British Society of Gastroenterology 10 guidelines maintain that management of IBS should be within the setting of primary care. If these are unremarkable, a diagnosis of IBS can be made. 2 Basic blood tests are performed on patients who fulfil these criteria. This stratification of IBS allows for more effective management of patient symptoms.Ĭurrent guidance is that a diagnosis of IBS should be suspected in patients with abdominal pain relieved by defaecation or associated with abnormal stool, with or without abnormal frequency, and accompanied by two of the following: altered stool passage, abdominal bloating, symptoms worsened by eating and mucus per rectum. 8 9įour subtypes of IBS have been described, each dependent on prominent stool pattern: 2 IBS with constipation (IBS-C), IBS with diarrhoea, mixed IBS (IBS-M) and unsubtyped IBS (in which stool pattern does not match those previously described). Both Manning and Rome criteria have been criticised for their lack of accuracy and specificity, which can be better obtained by the physician from a thorough history. 2 The Manning criteria include relief of pain with bowel movements, while the Rome criteria define IBS as recurrent abdominal pain associated with altered defaecation. The Manning criteria were originally developed in 1978, 6 followed by the Rome criteria in 1992, 7 which have been periodically revised (Rome III criteria). ![]() In an effort to standardise diagnosis, symptom-dependent criteria have been developed. The diagnosis of IBS can be challenging, as there is no biological disease marker. More women are affected than men, with an OR of 1.67. 4 However, this is likely to be an underestimate, since many people never consult their general practitioner. This equates to a total of 12% of the UK population. 4 In the UK specifically, the prevalence of IBS was found to be 4.8% formally diagnosed and 7.2% not formally diagnosed. 3Ĭurrent evidence suggests an average prevalence of IBS in Europe of 11.5%. 2 Although IBS does not cause pathological damage to the bowel wall, for some, it can cause pain and significantly affect their quality of life. Characteristic symptoms include disordered defaecation (constipation or diarrhoea), abdominal distension and abdominal pain and cramping, relieved by defaecation. 1 IBS is a chronic and relapsing disorder. Functional gastrointestinal disorders, including functional dyspepsia and irritable bowel syndrome (IBS), are common and account for 40–60% of referrals to gastroenterology outpatient clinics. ![]()
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