Cited by 477Gastrointestinal motility and disordersPsychosomatic Disorders and Their TreatmentsInfant Health and Development

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Irritable bowel syndrome in general practice: prevalence, characteristics, and referral

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Thompson, W G, Heaton, K W, Smyth, G T, Smyth, C·2000·Gut

DOI 10.1136/gut.46.1.78PMC PMC1727778

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Abstract

BACKGROUND AND AIMS: Little is known about the prevalence, symptoms, diagnosis, attitude, and referral to specialists of patients with irritable bowel syndrome (IBS) in general practice. This study aimed to determine these characteristics. METHODS: 3111 patients attending 36 general practitioners (GPs) at six varied locations in and near Bristol, UK, were screened to identify those with a gastrointestinal problem. These patients (n=255) and their doctors were given questionnaires. Six months later the case notes were examined to reach criteria based diagnoses of functional bowel disorders. RESULTS: Of 255 patients with a gastrointestinal complaint, 30% were judged to have IBS and 14% other functional disorders. Compared with 100 patients with an “organic” diagnoses, those with IBS were more often women and more often judged by their GP to be polysymptomatic and to have unexplained symptoms. The majority of patients with IBS (58%) were diagnosed as such by the GP; 22% had other functional diagnoses. Conversely, among 54 patients diagnosed as having IBS by the GPs, the criteria based diagnosis was indeed functional in 91%; only one patient had organic disease (proctitis). More patients with IBS than those with organic disease feared cancer. In most some fear remained after the visit to the doctor. On logistic regression analysis, predictors of referral to a specialist (29% referred) were denial of a role for stress, multiple tests, and frequent bowel movements. CONCLUSIONS: Half the patients with gut complaints seen by GPs have functional disorders. These are usually recognised, and few patients are referred. In IBS, cancer fears often remain, suggesting unconfident diagnosis or inadequate explanation.

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Psychological Factors in Irritable Bowel Syndrome: a Population-based Study of Patients, Non-patients and Controls
Weinryb, R. M., Österberg, E., Blomquist, L., Hultcrantz, R., Krakau, I., & Åsberg, M. (2003) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365520310002166 · Cited by 45
“IBS is the most common gastrointestinal (GI) condition seen by general practitioners (8) and accounts for between 20% and 50% of the referrals to gasteroenterology clinics (2, 9).”
Background
Preliminary Study of a Self-Administered Treatment for Irritable Bowel Syndrome: Comparison to a Wait List Control Group
Sanders, K. A., Blanchard, E. B., & Sykes, M. A. (2007) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-007-9037-7 · Cited by 43
“The majority of IBS patients are managed by a Primary Care Provider (PCP; Hungin et al. 2003; Thompson et al. 2000; Everhart and Renault 1991).”
Background
Psychosocial factors at work and in every day life are associated with irritable bowel syndrome
Faresjö, Å., Grodzinsky, E., Johansson, S., Wallander, M.-A. A., Timpka, T., & Åkerlind, I. (2007) · European Journal of Epidemiology · doi:10.1007/s10654-007-9133-2 · Cited by 45
“Approximately 7–20% of the general population has IBS-like symptoms and can be positively diagnosed on the basis of symptoms alone [3, 4].”
Background
Beliefs about management of irritable bowel syndrome in primary care: cross-sectional survey in one locality
Shivaji, U. N., & Ford, A. C. (2014) · Primary Health Care Research & Development · doi:10.1017/s1463423614000383 · Cited by 43
“Despite the fact that most research into the pathophysiology and treatment of IBS is conducted by Gastroenterologists in secondary or tertiary care, the majority of patients are dealt within primary care, with only a minority being referred on to see a specialist (Thompson et al., 2000).”
Background
Prevalence of irritable bowel syndrome-like symptoms using Rome IV criteria in patients with inactive inflammatory bowel disease and relation with quality of life
Özer, M., Bengı, G., Çolak, R., Cengiz, O., & Akpınar, H. (2020) · Medicine · doi:10.1097/md.0000000000020067 · Cited by 44
GPs' explanatory models for irritable bowel syndrome: a mismatch with patient models?
Casiday, R., Hungin, A. P. S., Cornford, C. S., de Wit, N. J., & Blell, M. T. (2008) · Family Practice · doi:10.1093/fampra/cmn088 · Cited by 43
Understanding symptom burden and attitudes to irritable bowel syndrome with diarrhoea: Results from patient and healthcare professional surveys
Törnblom, H., Goosey, R., Wiseman, G., Baker, S. G., & Emmanuel, A. V. (2018) · United European Gastroenterology Journal · doi:10.1177/2050640618787648 · Cited by 45
Diagnostic Yield of Colonoscopy in Patients With Symptoms Compatible With Rome IV Functional Bowel Disorders
Asghar, Z., Thoufeeq, M., Kurien, M., Ball, A. J., Rej, A., Tai, F. W. D., Afify, S., & Aziz, I. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.08.062 · Cited by 44
The Role of Fiber in the Treatment of Irritable Bowel Syndrome
Zuckerman, M. J. (2005) · Journal of Clinical Gastroenterology · doi:10.1097/01.mcg.0000196405.15110.bb · Cited by 42
“Fiber and bulking agents are often prescribed by physicians.(15,17) Clinicians may also make dietary recommendations for treatment of diarrhea and abdominal pain or bloating.”
Background
The spectrum of irritable bowel syndrome: A clinical review
Gilkin, R. J. (2005) · Clinical Therapeutics · doi:10.1016/j.clinthera.2005.11.012 · Cited by 42
Homeopathy for treatment of irritable bowel syndrome
Peckham, E. J., Nelson, E. A., Greenhalgh, J., Cooper, K. L., Roberts, E. R., & Agrawal, A. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009710.pub2 · Cited by 43
Irritable bowel syndrome and chronic pelvic pain: A singular or two different clinical syndrome?
Matheis, A. (2007) · World Journal of Gastroenterology · doi:10.3748/wjg.v13.i25.3446 · Cited by 40
Faecal calprotectin effectively excludes inflammatory bowel disease in 789 symptomatic young adults with/without alarm symptoms: a prospective UK primary care cohort study
Walker, G., Moore, L., Heerasing, N. M., Hendy, P. J., Perry, M. H., McDonald, T. J., Debenham, T., Bethune, R. M., Bewshea, C., Hyde, C., et al. (2018) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.14563 · Cited by 41
“Symptom duration (mo) 6 [3-12] 4 [2-8] 0.”
Background
Patient Satisfaction With Alosetron for the Treatment of Women With Diarrhea-Predominant Irritable Bowel Syndrome
Olden, K. W., DeGarmo, R. G., Jhingran, P. M., Bagby, B., Decker, C., Markowitz, M., & Carter, E. (2002) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2002.07111.x · Cited by 40
“8) Race, n (%) White 495 (93) 253 (94) Black 18 (3) 11 (4) Asian 2 ( 1) 0 (0) Hispanic 15 (3) 4 (1) Other 2 ( 1) 1 ( 1) IBS subtype, n (%) Diarrhea predominant 521 (98) 262 (97) Alternator 11 (2) 7 (3) Mean time since symptom onset, yr (SD) 11.”
Background
Do We Know What Patients Want? The Doctor-Patient Communication Gap in Functional Gastrointestinal Disorders
Collins, J. E., Farrall, E., Turnbull, D. A., Hetzel, D. J., Holtmann, G., & Andrews, J. M. (2009) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2009.06.025 · Cited by 40
Perceived food and drug allergies in functional and organic gastrointestinal disorders
Bhat, K., Harper, A., & Gorard, S. A. C. (2002) · Alimentary Pharmacology & Therapeutics · doi:10.1046/j.1365-2036.2002.01256.x · Cited by 39
Therapeutic Effects of Biobran, Modified Arabinoxylan Rice Bran, in Improving Symptoms of Diarrhea Predominant or Mixed Type Irritable Bowel Syndrome: A Pilot, Randomized Controlled Study
Kamiya, T., Shikano, M., Tanaka, M., Ozeki, K., Ebi, M., Katano, T., Hamano, S., Nishiwaki, H., Tsukamoto, H., Mizoshita, T., et al. (2014) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2014/828137 · Cited by 39
Health-related quality of life of irritable bowel syndrome patients in different cultural settings
Faresjö, Å., Anastasiou, F., Lionis, C. D., Johansson, S., Wallander, M.-A. A., & Faresjö, T. (2006) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-4-21 · Cited by 39
A single session of reassurance can acutely improve the self-perception of impairment in patients with IBS
Schmulson, M. J., Ortiz-Garrido, O. M., Hinojosa, C., & Arcila, D. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.02.011 · Cited by 38
“In a British study of patients with IBS and cancer phobia from a general medical practice, only 26% appeared to have received medical information during their consultation because they felt better about their symptoms after the visit [18].”
BackgroundMethodInfluential
Calculating Total Health Service Utilisation and Costs from Routinely Collected Electronic Health Records Using the Example of Patients with Irritable Bowel Syndrome Before and After Their First Gastroenterology Appointment
Canavan, C., West, J., & Card, T. R. (2015) · PharmacoEconomics · doi:10.1007/s40273-015-0339-y · Cited by 39
“It has previously been found that the factors most likely to predict referral to a gastroenterologist are reporting stress worsening symptoms and having more than three bowel movements per day, which are not variables recorded within the CPRD and HES dataset [13].”
Background
Is there an added value of faecal calprotectin and haemoglobin in the diagnostic work-up for primary care patients suspected of significant colorectal disease? A cross-sectional diagnostic study
Elias, S. G., Kok, L., de Wit, N. J., Witteman, B. J. M., Goedhard, J. G., Romberg-Camps, M. J. L., Muris, J. W. M., & Moons, K. G. M. (2016) · BMC Medicine · doi:10.1186/s12916-016-0684-5 · Cited by 38
“Background Patients with persistent lower abdominal complaints are common in primary care [1].”
Functional Bowel Disorders in Adults
Häuser, W., Layer, P., Henningsen, P., & Kruis, W. (2012) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2012.0083 · Cited by 38
The Effects of Lifestyle Modification on Symptoms and Quality of Life in Patients with Irritable Bowel Syndrome: A Prospective Observational Study
Kang, S. H., Choi, S.-W., Lee, S. J., Chung, W., Lee∥, H. R., Chung, K.-Y., Lee, E. S., Moon, H. S., Kim, S. H., Sung, J. K., et al. (2011) · Gut and Liver · doi:10.5009/gnl.2011.5.4.472 · Cited by 37
Disorders of gut‐brain interaction: Highly prevalent and burdensome yet under‐taught within medical education
Simons, J., Shajee, U., Palsson, O. S., Simrén, M., Sperber, A. D., Törnblom, H., Whitehead, W. E., & Aziz, I. (2022) · United European Gastroenterology Journal · doi:10.1002/ueg2.12271 · Cited by 38
“Indeed, DGBI are amongst the most commonly encountered gastrointestinal conditions seen within clinical practice, with conditions such as irritable bowel syndrome accounting for almost a third of all gastroenterology cases seen in primary care.(4) These conditions are costly both to the patient and healthcare sector d…”
Background
Randomised, placebo‐controlled trial and meta‐analysis show benefit of ondansetron for irritable bowel syndrome with diarrhoea: The TRITON trial
Gunn, D., Topan, R., Barnard, L., Fried, R., Holloway, I., Brindle, R., Corsetti, M., Scott, M., Farmer, A., Kapur, K., et al. (2023) · Alimentary Pharmacology and Therapeutics · doi:10.1111/apt.17426 · Cited by 32
Irritable bowel syndrome: Is it “irritable brain” or “irritable bowel”?
Padhy, S. K., Sahoo, S., Mahajan, S., & Sinha, S. K. (2015) · Journal of Neurosciences in Rural Practice · doi:10.4103/0976-3147.169802 · Cited by 38
“[2] In the Western world, IBS appears to affect up to 20% of the population at any given time, although the prevalence figures vary substantially depending on the definition of IBS.[3] On the contrary in Asian countries, the median value of IBS prevalence defined by various criteria ranges 6.”
Quality improvement project identifies factors associated with delay in IBD diagnosis
Walker, G., Lin, S., Chanchlani, N., Thomas, A., Hendy, P. J., Heerasing, N. M., Moore, L., Green, H., Chee, D., Bewshea, C., et al. (2020) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15885 · Cited by 35
Prevalence and Impact of Upper and Lower Gastrointestinal Symptoms in the Greek Urban General Population
Papatheodoridis, G., & Karamanolis, D. G. (2005) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365520510012271 · Cited by 35
“epidemiologic studies have evaluated separately the prevalence of symptoms of only the upper [3,11 /14] or, more rarely, only the lower GI tract [15].”
Background
Blastocystis Isolates from Patients with Irritable Bowel Syndrome and from Asymptomatic Carriers Exhibit Similar Parasitological Loads, but Significantly Different Generation Times and Genetic Variability across Multiple Subtypes
Vargas-Sanchez, G.-B., Romero‐Valdovinos, M., Ramirez-Guerrero, C., Vargas-Hernandez, I., Ramírez-Miranda, M. E., Martínez-Ocaña, J., Valadéz, A., Ximénez, C., López-Escamilla, E., Hernández‐Campos, M. E., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0124006 · Cited by 34
A systematic review of minimal-contact psychological treatments for symptom management in Irritable Bowel Syndrome
Pajak, R., Lackner, J. M., & Kamboj, S. K. (2013) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2013.05.007 · Cited by 41
“Revisions of the Rome diagnostic criteria have led to improved specificity and sensitivity of diagnosis [88,89] although this remains less reliable when performed by family doctors [90].”
Method
Contrasting effects of comorbidities on emergency colon cancer diagnosis: a longitudinal data-linkage study in England
Renzi, C., Lyratzopoulos, G., Hamilton, W. T., Maringe, C., & Rachet, B. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4075-4 · Cited by 43
“IBS prevalence in the general population varies widely [52], depending on diagnostic criteria and data sources [39], but what is noteworthy here is the increase during the pre-diagnostic months.”
Background
Applying Case Definition Criteria to Irritable Bowel Syndrome
Yale, S. H., Musana, K. A., Kieke, A., Hayes, J., Glurich, I., & Chyou, P.-H. (2008) · Clinical Medicine & Research · doi:10.3121/cmr.2008.788 · Cited by 34

Authors: Thompson, W. G., Heaton, K. W., Smyth, G. T., & Smyth, C.
Affiliations: University of Ottawa (CA)
Corresponding author: Thompson, W G
ORCID: Thompson, W G
Venue: Gut
Publisher: BMJ
Published: 2000-01-01
Volume: 46
Issue: 1
Pages: 78-82
ISSN: 0017-5749 (ISSN-L)
1468-3288
DOI: 10.1136/gut.46.1.78
PMC: PMC1727778
OpenAlex: W2137007351
Cited by: 477
References: 21
Citations by year: 2026: 2 · 2025: 6 · 2024: 10 · 2023: 12 · 2022: 6 · 2021: 9 · 2020: 11 · 2019: 10 · 2018: 18 · 2017: 17 · 2016: 17 · 2015: 14 · 2014: 22 · 2013: 21 · 2012: 22
FWCI: 25.59
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Gut (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Topics: Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Health and Development
Keywords: irritable bowel syndrome, functional bowel disorders, general practice, prevalence, specialist referral, fear of cancer, diagnostic criteria, proctitis
MeSH terms: Adolescent, Adult, Aged, Aged, 80 and over, Attitude to Health, Colonic Diseases, Functional, England, Family Practice, Female, Follow-Up Studies, Humans, Male, Mass Screening, Middle Aged, Neoplasms, Referral and Consultation, Cohort Studies, Prevalence

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Irritable bowel syndrome in general practice: prevalence, characteristics, and referral

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