How general practitioners manage patients with irritable bowel syndrome. Data from a German urban area.Rom J Intern Med 2009; 47(1):47-53RJ
Irritable bowel syndrome (IBS) is a common functional disorder in the general Western population. The majority of patients with IBS are managed by general practitioners (GP). Therefore, it is very important that GP are well trained in the approach to functional gastrointestinal disorders. There is the impression that the knowledge of diagnostic IBS criteria may be deficient in GPs. The present study is a survey of the knowledge and management of general practitioners in Germany regarding IBS.
All general practitioners (n=260) of an urban area with about 600,000 inhibitants were asked by mail to complete a multiple choice questionnaire concerning their knowledge on IBS and their management of IBS patients.
A completed questionnaire was returned by 121 of the general practitioners (46.5% response rate). The majority of the responders were male (61%) and had an experience exceeding 10 years (75%). IBS was regarded as a functional disorder by 55% (49% as a motility disorder and 66% as a psychic disorder). The diagnosis of IBS was mainly based on the patient's history, a colonoscopy was considered by 57%. Diagnostic criteria for IBS were used only by 22 GPs (18%). Referral to gastroenterologists was initiated by 26% of the GPs in all patients with suspected IBS. The majority referred patients only in case of unclear diagnosis or insufficient therapeutic results. Medical therapy was prescribed by 96% of the GPs. Psychotherapy and alternative therapies were additionally performed by 55% and 61%, respectively. The majority of the GPs (66%) estimated the percentage of IBS patients in their daily routine between 1 and 10% and stated that they have seen 1 to 5 patients during the past week.
Diagnostic IBS criteria such as Rome criteria are largely unknown among GPs in our area. Pathogenetic models of IBS are deficiently known in GPs. It is likely that the minority of patients who are referred to gastroenterologists have special problems. Their management should probably be different from that of the unreferred majority. Many therapeutic modalities in primary care have no medical evidence. Further studies on therapy options in IBS should also be made in primary care.