Commentary: Controversies in NICE guidance on irritable bowel syndrome

Published on Mar 6, 2008in BMJ30.223
· DOI :10.1136/BMJ.39504.409329.AD
Nicholas J. Talley183
Estimated H-index: 183
(Mayo Clinic)
Sources
Abstract
The NICE guidelines summarise the diagnosis and treatment of irritable bowel syndrome (IBS), but several issues remain contentious. The NICE guidelines offer a pragmatic definition of IBS, similar to one published in 2002 by the American College of Gastroenterology Taskforce.1 However, the utility of these pragmatic definitions is unknown. The Rome criteria for IBS were developed for research purposes and are specific, but there are no adequate validation data documenting their applicability in primary care.1 2 The NICE guidelines suggest that symptoms that are made worse by eating support a diagnosis of IBS, but as acknowledged in the guidelines, this is based on expert consensus rather than research evidence. Clinicians need to be aware that this symptom may lead to confusion with functional dyspepsia and peptic ulcer disease. Making …
📖 Papers frequently viewed together
200830.22BMJ
75 Citations
9 Citations
42 Citations
References7
Newest
#1William E. Whitehead (UNC: University of North Carolina at Chapel Hill)H-Index: 102
#2Olafur S. Palsson (UNC: University of North Carolina at Chapel Hill)H-Index: 50
Last. Douglas A. Drossman (UNC: University of North Carolina at Chapel Hill)H-Index: 103
view all 7 authors...
Summary Background Studies suggest that the positive predictive value of the Rome II criteria for diagnosing irritable bowel syndrome can be enhanced by excluding red flag symptoms suggestive of organic diseases. Aim We assessed the utility of red flags for detecting organic diseases in patients diagnosed irritable bowel syndrome by their physicians. Methods Systematic chart reviews were completed in 1434 patients with clinical diagnoses of irritable bowel syndrome, abdominal pain, diarrhoea or ...
82 CitationsSource
#1Jan Tack (Katholieke Universiteit Leuven)H-Index: 126
#1J. Tack (Katholieke Universiteit Leuven)H-Index: 9
Last. Jozef JanssensH-Index: 45
view all 6 authors...
Introduction: Selective serotonin reuptake inhibitors (SSRIs) are frequently used in the treatment of irritable bowel syndrome (IBS) although evidence of their efficacy is scarce. Aim: Twenty three non-depressed IBS patients were recruited from a tertiary care centre and included in a crossover trial comparing six weeks of treatment with the SSRI citalopram (20 mg for three weeks, 40 mg for three weeks) with placebo. IBS symptom severity was the primary outcome measure, and depression and anxiet...
225 CitationsSource
#1Johann HammerH-Index: 21
#2Guy D. Eslick (USYD: University of Sydney)H-Index: 62
Last. Nicholas J. Talley (Mayo Clinic)H-Index: 183
view all 5 authors...
Objective: The diagnostic value of the addition of alarm symptoms in distinguishing functional from organic gastrointestinal disease remains uncertain. We aimed to establish the value of alarm features in differentiating between organic disease and irritable bowel syndrome (IBS) and functional dyspepsia (FD). Methods: A total of 568 consecutive patients (63% female; mean age 44.7 years) completed a detailed symptom questionnaire and then received a complete diagnostic workup, as required. Questi...
137 CitationsSource
#1Judith M. E. Walsh (UCSF: University of California, San Francisco)H-Index: 28
ContextScreening for colorectal cancer clearly reduces colorectal cancer mortality, yet many eligible adults remain unscreened. Several screening tests are available, and various professional organizations have differing recommendations on which screening test to use. Clinicians are challenged to ensure that eligible patients undergo colorectal cancer screening and to guide patients in choosing what tests to receive.ObjectiveTo critically assess the evidence for use of the available colorectal c...
375 CitationsSource
#1Lawrence J. Brandt (Yeshiva University)H-Index: 10
#2David J. Bjorkman (Yeshiva University)H-Index: 28
Last. Nicholas Talley (Yeshiva University)
view all 10 authors...
244 CitationsSource
#1David S. Sanders (Royal Hallamshire Hospital)H-Index: 81
#2M J Carter (Royal Hallamshire Hospital)H-Index: 15
Last. Alan J. Lobo (Royal Hallamshire Hospital)H-Index: 44
view all 7 authors...
Summary Background Irritable bowel syndrome has a high prevalence. Consensus diagnostic criteria (ROME II) based on symptoms have been established to aid diagnosis. Although coeliac disease can be misdiagnosed as irritable bowel syndrome, no prospective study has been published in which patients with this disorder are investigated for coeliac disease. We aimed to assess the association of coeliac disease with irritable bowel syndrome in patients fulfilling ROME II criteria. Methods We undertook ...
328 CitationsSource
Abstract Summary Whilst following up large numbers of patients with irritable bowel syndrome we got the impression that wholemeal wheat and bran products made people with the condition worse rather than better. One hundred consecutive new referrals, all of whom had tried bran, were questioned to resolve this issue. 55% of patients were made worse by bran whereas only 10% had found it helpful. With the exception of fruit, other forms of dietary fibre were not as detrimental and proprietary supple...
253 CitationsSource
Cited By4
Newest
#1Regina Sierżantowicz (UMB: Medical University of Białystok)H-Index: 3
#2Jolanta Lewko (UMB: Medical University of Białystok)H-Index: 7
Last. Grażyna Jurkowska (UMB: Medical University of Białystok)H-Index: 6
view all 3 authors...
Background: Irritable bowel syndrome (IBS) is one of the most common functional diseases of the gastrointestinal tract. A typical symptom is changed bowel patterns: diarrhea, constipation, or alternation of the two. Abdominal pains vary in intensity and location, with periods of exacerbation and remission, causing disorganization in everyday life and work. Educational intervention could be one strategy to improve the well-being of IBS patients. Only a few trials have examined this hypothesis. Th...
Source
#1Philip Keightley (ANU: Australian National University)H-Index: 4
#2Paul Pavli (ANU: Australian National University)H-Index: 25
Last. Jeffrey C.L. Looi (ANU: Australian National University)H-Index: 23
view all 4 authors...
Objective:Psychiatrists are likely to encounter patients with irritable bowel syndrome (IBS). We aim to provide a clinically-focused summary of psychiatric comorbidities and management.Conclusions:IBS affects up to 15% of the population. Antidepressants and brief psychotherapy can reduce symptom severity and improve coping. These treatments are effective for patients without comorbid mental illness, as well as those with increased somatisation, health-care seeking and sexual abuse histories.
4 CitationsSource
#2Hazel Everitt (University of Southampton)H-Index: 22
Source
Source