IBS Guidelines and Online Patient Tools Helpful for Diagnosis, Treatment

Paula Moyer

June 03, 2009

June 3, 2009 — A recently published evidence-based review of irritable bowel syndrome (IBS) management and the release of online patient tools by the American College of Gastroenterology (ACG) may help diagnose the disease with fewer costly tests and guide IBS therapy decisions.

"IBS is one of the most common diseases worldwide and also has a global impact," said Eammon M. M. Quigley, MD, during a press conference May 29. Dr. Quigley is as professor of medicine and human physiology at the National University of Ireland in Cork, Ireland. He is also the president of ACG and the World Gastroenterological Organisation. He stressed that physicians should assure patients that IBS does not lead to cancer and also acknowledge that it is a significant condition for patients to live with.

"One in 8 people in the United States has IBS, and we're just learning what's behind it," Lawrence R. Schiller, MD, said during the press conference. He is a clinical professor at the University of Texas Southwestern Medical Center in Dallas and program director of the Gastroenterology Fellowship Training Program at Baylor University Medical Center, also in Dallas.

New Understanding of IBS

The new understanding of the pathophysiology of IBS, and therefore new therapies, were the reasons the ACG IBS Task Force published the review and developed the patient tools, Dr. Schiller said. "IBS may be a discoordination between the intestines and the motor nerves."

He pointed out that physicians use many treatments for IBS. These include, but are not limited to, fiber supplements in patients with constipation-predominant IBS, antispasmodics, chloride channel agonists such as lubiprostone (Amitza), and the serotonin antagonist alosetron (Lotronex), as well as antibiotics, probiotics, and a variety of complementary and alternative remedies. In addition, some patients benefit from hypnotherapy, group therapy, and individual psychotherapy, Dr. Quigley said, stressing that the practitioner needs to be a licensed psychotherapist.

"When we prescribe antidepressants for IBS, we are not thinking that patients have IBS because they are depressed," he said. "We use them because of their specific effect on the gut."

Dr. Schiller pointed out that the new evidence-based review evaluates the quality of evidence for many types of therapies, including complementary and alternative therapies. He encouraged his colleagues to "try to be broad-minded" about these approaches and to share the findings regarding them with patients. He also encouraged physicians to ask patients whether they have taken them.

Online Tools May Help Tailor Treatment

The online interactive patient tools consist of both a questionnaire to help patients determine whether their symptoms are consistent with IBS and a treatment matrix in which patients check treatments they have tried. The responses to the questionnaire and the treatment matrix will help tailor the treatment approach to the individual patient, Dr. Quigley said.

"The patient tools help patients and physicians focus on symptoms and their impact on daily life," he told Medscape Gastroenterology. "They allow both patients and physicians to look at all of the treatment options and see how they stack up in terms of levels of evidence."

"The tools bring the patient's results to the appointment so that the physician can 'get down to brass tacks,' " Dr. Schiller told Medscape Gastroenterology. "The results introduce the physician to the patient's case right away."

"This review is timely because there has been an explosion of new information addressing the pathophysiology for IBS, the most appropriate diagnostic strategies, and best treatments," William Chey, MD, told Medscape Gastroenterology in a separate phone interview. Dr. Chey, a coauthor of the guidelines, is a professor of medicine in gastroenterology at the University of Michigan Health System in Ann Arbor. "We have new data on treatments that were not available when the review was first developed in 2002. For example, there were no sections on chloride channel agonists, probiotics, or antibiotics."

The data in the review show that "most diagnostic testing ordered by physicians [to diagnose IBS] is probably unnecessary," he said. "If you look at the likelihood of identifying important organic diseases and the tests we commonly use to diagnose these, the probability of finding such a disease is unlikely in patients with IBS symptoms, particularly those with no warning signs or alarm features. However, people whose conditions raise red flags should be screened." Patients with diarrhea-predominant IBS should be screened by a blood test for celiac disease, he said.

"The IBS Test Tool will be helpful for patients who are suffering from symptoms and not sure if they represent IBS," Dr. Chey said. "Although the treatment matrix is geared to patients, it can also be used by physicians."

Am J Gastroenterol. 2009;104(suppl 1):s1–s35.

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