An exploration of the barriers to the confident diagnosis of irritable bowel syndrome: A survey among general practitioners, gastroenterologists and experts in five European countries

Abstract

Background: The diagnostic processes for chronic abdominal conditions are challenging. Despite their tendency for diagnostic tests in patients with irritable bowel syndrome (IBS) symptoms, clinicians are encouraged to make a positive diagnosis based on symptom criteria without alarm signs. We explored how European physicians diagnose and manage patients suffering from IBS.

Methods: We conducted a vignette-based survey to evaluate the diagnostic approaches in four standardized patients with IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), inflammatory bowel disease (IBD) and chronic constipation (CC). General practitioners (GP, n = 104), gastroenterologists (GE, n = 100) and IBS experts (n = 25) from five European countries participated.

Results: Experts showed the highest rates of correct diagnoses (88%-92%) for all cases except CC (only 60%) and were more prone to a positive diagnosis (64%/68% in IBS-C/CC), whereas GEs and GPs tended toward a diagnosis by exclusion (63%/63% and 62%/60% in IBS-C/CC). In the CC vignette, conducting tests was more frequent than prescribing treatment among 44% experts, 63% GEs and 36% GPs. The diagnosis of IBD presented little difficulty for any of the participants.

Conclusions: This study highlights the difficulties in confidently diagnosing chronic functional bowel conditions, especially for non-experts, whereas IBD caused little difficulty. Differentiating between IBS-C and CC seemed particularly challenging, even for experts.

Keywords: Chronic constipation; IBS-C; diagnostic approach; guidelines.

Figures

Figure 1.

Ability to diagnose irritable bowel syndrome with constipation (IBS-C), with diarrhea (IBS-D), inflammatory bowel disease (IBD) and chronic constipation (CC) on the basis of patient history and physical examination findings in patients’ vignette. Participants were asked: “Based on the information you just read, do you consider this patient to be more likely…?” The figure depicts the percentages by group giving a correct or incorrect answer or responding “Unsure — need more information.” GEs: gastroenterologists; GPs: general practitioners.

Figure 2.

Overall knowledge and needs in irritable bowel syndrome. Participants were asked: For diagnosis process: “Based on your clinical experience, do you consider IBS, in general, to be?” For the interest regarding information on IBS: “To what extent would you be interested in the following aspects using a scale of 1–9, where 1 means ‘not at all’ and 9 ‘very’?” Percentages presented represent the rates of participants who gave a score of 7–9. For reference to guidelines: “During IBS diagnosis process, if you refer to guidelines, which guidelines do you generally refer to?” The figure depicts the percentages by group for each possible answer. IBS: irritable bowel syndrome; GPs: general practitioners; GEs: gastroenterologists.

Figure 3.

Overall perception of diagnosis process. Participants were asked: “Please assess your overall perception of IBS diagnosis process, using a scale from 1 to 9, where 1 means ‘not at all’ and 9 ‘very.’” The figure depicts the percentages by group for each possible answer. Percentages represent the rates of participants who gave a score of 7–9. IBS: irritable bowel syndrome; GPs: general practitioners; GEs: gastroenterologists.