In the Journals

Many people with IBS-D symptoms remain undiagnosed

Symptoms related to diarrhea-predominant irritable bowel syndrome significantly impact quality of life, yet a substantial proportion of individuals who meet criteria for IBS-D remain undiagnosed and untreated, according to the results of an online survey.

“The data suggest that formal IBS-D diagnoses may be important for two reasons,” the researchers wrote. “First, an IBS diagnosis may facilitate the dialogue between the patient and physician about treatment options. Patients diagnosed with IBS-D were offered more treatments and were found to have greater access to evidence-based, proven therapies.”

Second, diagnosed patients “appeared to be better informed about IBS pathophysiology, reporting explanations for their symptoms that are more scientifically derived ... compared with undiagnosed individuals. Conversely, one-third of those without an IBS-D diagnosis reported that they had been provide no explanation by their health care provider for their GI symptoms.”

To compare symptoms, health care use, quality of life, treatments and perceived explanations for symptoms between people with diagnosed vs. undiagnosed IBS-D, investigators surveyed 1,924 adults from a general U.S. population sample who reported they had experienced GI issues in previous surveys. The questionnaire “assessed the frequency and severity of GI symptoms, number and type of health care visits, general well-being, management of symptoms and treatment satisfaction.”

Overall, 1,094 (56.9%) of respondents met Rome III criteria for IBS-D, but 830 of those who met criteria (43.1% of all respondents) had not been diagnosed. Among those who were undiagnosed despite meeting criteria, 53% had never spoken with a physician about their GI symptoms.

Among diagnosed patients, 45% were diagnosed by a gastroenterologist, 42% by a primary care physician and 11% by an internist.

Diagnosed patients were more often white and female compared with undiagnosed individuals (P < .05), tended to be older, were twice as likely to have severe GI symptoms (16% vs. 8%; P < .05), and were significantly more likely to have GI symptoms for more than 10 years (55% vs. 18%; P < .05).

Conversely, undiagnosed individuals were more likely to have mild symptoms (6% vs. 3%; P < .05), have symptoms for less than 3 years (51% vs. 14%; P < .05), and experience “confounder” symptoms like heartburn, gastric reflux and constipation compared with diagnosed patients.

While both diagnosed and undiagnosed respondents reported their quality of life was adversely affected by their GI symptoms, this was significantly more common among diagnosed patients (P < .05).

Most respondents (about 40%) received treatment for their symptoms from primary care physicians, but diagnosed patients were more likely to receive treatment from a gastroenterologist (23% vs. 9%; P < .05). Overall, 26% of diagnosed patients and 43% of undiagnosed patients were not being treated.

The researchers concluded that “it is important that providers maintain an appropriate index of suspicion in diagnosing IBS.” – by Adam Leitenberger

Disclosures: The study was funded by Salix Pharmaceuticals. Sayuk reports he is a speaker for Ironwood/Allergan. Please see the full study for a list of all other researchers’ relevant financial disclosures.

Symptoms related to diarrhea-predominant irritable bowel syndrome significantly impact quality of life, yet a substantial proportion of individuals who meet criteria for IBS-D remain undiagnosed and untreated, according to the results of an online survey.

“The data suggest that formal IBS-D diagnoses may be important for two reasons,” the researchers wrote. “First, an IBS diagnosis may facilitate the dialogue between the patient and physician about treatment options. Patients diagnosed with IBS-D were offered more treatments and were found to have greater access to evidence-based, proven therapies.”

Second, diagnosed patients “appeared to be better informed about IBS pathophysiology, reporting explanations for their symptoms that are more scientifically derived ... compared with undiagnosed individuals. Conversely, one-third of those without an IBS-D diagnosis reported that they had been provide no explanation by their health care provider for their GI symptoms.”

To compare symptoms, health care use, quality of life, treatments and perceived explanations for symptoms between people with diagnosed vs. undiagnosed IBS-D, investigators surveyed 1,924 adults from a general U.S. population sample who reported they had experienced GI issues in previous surveys. The questionnaire “assessed the frequency and severity of GI symptoms, number and type of health care visits, general well-being, management of symptoms and treatment satisfaction.”

Overall, 1,094 (56.9%) of respondents met Rome III criteria for IBS-D, but 830 of those who met criteria (43.1% of all respondents) had not been diagnosed. Among those who were undiagnosed despite meeting criteria, 53% had never spoken with a physician about their GI symptoms.

Among diagnosed patients, 45% were diagnosed by a gastroenterologist, 42% by a primary care physician and 11% by an internist.

Diagnosed patients were more often white and female compared with undiagnosed individuals (P < .05), tended to be older, were twice as likely to have severe GI symptoms (16% vs. 8%; P < .05), and were significantly more likely to have GI symptoms for more than 10 years (55% vs. 18%; P < .05).

Conversely, undiagnosed individuals were more likely to have mild symptoms (6% vs. 3%; P < .05), have symptoms for less than 3 years (51% vs. 14%; P < .05), and experience “confounder” symptoms like heartburn, gastric reflux and constipation compared with diagnosed patients.

While both diagnosed and undiagnosed respondents reported their quality of life was adversely affected by their GI symptoms, this was significantly more common among diagnosed patients (P < .05).

Most respondents (about 40%) received treatment for their symptoms from primary care physicians, but diagnosed patients were more likely to receive treatment from a gastroenterologist (23% vs. 9%; P < .05). Overall, 26% of diagnosed patients and 43% of undiagnosed patients were not being treated.

The researchers concluded that “it is important that providers maintain an appropriate index of suspicion in diagnosing IBS.” – by Adam Leitenberger

Disclosures: The study was funded by Salix Pharmaceuticals. Sayuk reports he is a speaker for Ironwood/Allergan. Please see the full study for a list of all other researchers’ relevant financial disclosures.