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Patients with irritable bowel syndrome (IBS) in general practice

Patients with irritable bowel syndrome (IBS) in general practice. Luise Mølenberg Begtrup The Departement of Gastroenterology , Odense University Hospital and Research Unit of General Practice, Institute of Public Health University of Southern Denmark.

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Patients with irritable bowel syndrome (IBS) in general practice

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  1. Patients with irritable bowel syndrome (IBS) in general practice Luise Mølenberg Begtrup The Departement of Gastroenterology, Odense University Hospital and Research Unit of General Practice, Institute of Public Health University of Southern Denmark LuiseMølenberg Begtrup lmbegtrup@health.sdu.dk

  2. ”How do we distinguish between the majority of people suffering from IBS and the minority of people suffering from organic disease” • Colorectal cancer • Inflammatory bowel • disease • Celiac sprue • Lactose intolerance IBS - patients ”Where´s Wally” LuiseMølenberg Begtrup lmbegtrup@health.sdu.dk

  3. Diagnosis of exclusion Positive diagnosis Diagnosis of a condition with no objective findings LuiseMølenberg Begtrup lmbegtrup@health.sdu.dk

  4. LuiseMølenberg Begtrup lmbegtrup@health.sdu.dk CRITERIA for DIAGNOSIS OF IBS Recurrentabdominalpainordiscomfort associatedwithtwoor more of the following: • Improvementwithdefecation • Onsetassociatedwithchange in frequency of stool • Onsetassociatedwithchange in form (appearance) of stool Duration more than 3 months, onset more than 6 monthago.Frequency of symptoms: at least 3 days / month Rome III critea (2006)

  5. LuiseMølenberg Begtrup lmbegtrup@health.sdu.dk A Positive diagnosis……. IBS criteriafulfilled Age < 50 years Alarm features Physicalexamination FBC, CRP, (screening for celiacsprue) NICE-guidelines 2008, AGA 2002, Clinical Services Committee of The British society of Gatroenterology 2007

  6. Diagnosis of exclusion Positive diagnosis LuiseMølenberg Begtrup lmbegtrup@health.sdu.dk

  7. Diagnosis of exclusion Positive diagnosis Diagnostic criteria + no alarm features has a positive predictive value = 98-100 % Vanner SJ, et al. AJG 1999 Pretest probability for organic disease < 1 % in patients meeting the criteria Cash et al. AJG 2002 1 : 1000 → perforation of the intestine 1 : 10.000 dies – when having diagnostic colonoscopy Anderson ML et. al. AJG 2000 Symptoms mimic symptoms of CRC and IBD The one young patient with cancer despite no alarm features Reassurance Patient´s wish / demand ”repeatedtestingsuggests an unconfidentdoctoror a patient withpersistentfears of organicdisease, perhapsonefostering the other” Thompsom et al. GUT 2002 LuiseMølenberg Begtrup lmbegtrup@health.sdu.dk

  8. LuiseMølenberg Begtrup lmbegtrup@health.sdu.dk If we suspect Irritabel bowel syndrome (IBS), only few investigations may be necessary. We cannot cure the IBS patients, but we can help them.

  9. IBS patient return visits compared with Phycisian-patient interaction Owens, D. M. et. al. Ann Intern Med 1995;122:107-112

  10. LuiseMølenberg Begtrup lmbegtrup@health.sdu.dk Phycisian-patient interaction • Psychosocial history • Precipitating factors • Involving the patient in the discussion of diagnosis and treatment Owens, D. M. et. al. Ann Intern Med 1995;122:107-112

  11. PROBIOTICS

  12. LuiseMølenberg Begtrup lmbegtrup@health.sdu.dk If we suspect irritabel bowel syndrome (IBS), only few investigations may be necessary. We cannot cure the IBS patients, but we can help them.

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