Irritable bowel syndrome in primary care

Abstract

Irritable bowel syndrome (IBS) is a functional bowel disorder in which abdominal pain or discomfort is associated with a change in bowel habit, or with features of disordered defecation. Patients and doctors in primary care generally agree on IBS symptomatology and consider pain and bloating as its main features. Consultation behaviour is mainly driven by the severity of IBS symptomatology, rather than by its impact on quality of life or psychological distress. Irritable bowel syndrome is associated with a high prevalence of comorbidity. Before the diagnosis the comorbidity levels are comparable to the prevalence in a random sample of patients from primary care. Somatic comorbidity is a common feature in the year of IBS diagnosis and drops afterwards, while functional and psychiatric disorders remain prevalent. These patients might need targeted treatment approaches. The subjective measurement “adequate relief of abdominal pain and discomfort” is currently the best choice for the outcome assessment in IBS research. In addition, an integrated IBS symptom scale may be used as a secondary outcome measure, of which the IBS symptom severity scale (IBS SSS) is presently the best available instrument. Finally, the IBS quality of life score (IBS-QOL) is the preferred scale to asses changes in health-related quality of life. Based on recruitment analysis of this randomised controlled trial (RCT) we conclude that patients randomised in IBS research do differ from eligible IBS patients with respect to type and intensity of symptoms and disease history, which might influence the applicability of the trial results. Therapy with soluble and insoluble fibre confer distinct effects in IBS; long-term psylium (soluble fibre) is more effective than placebo in reducing IBS symptoms. In contrast, bran, an insoluble fibre, showed no favourable outcome compared to placebo. Psyllium seems the preferred treatment in IBS patients.