Alternative Investigations for Irritable Bowel Syndrome

Hamish Philpott; Sanjay Nandurkar; John Lubel; Peter R Gibson

Disclosures

J Gastroenterol Hepatol. 2013;28(1):73-77. 

In This Article

Abstract and Introduction

Abstract

Background and Aim Alternative and complementary medical practitioners have long advocated alternative treatments for irritable bowel syndrome. A more recent development has been the use of alternative investigations by these practitioners and, in the era of internet advertising, directly by patients themselves. The aim of the present study was to examine the alternative investigations that are advocated for the assessment of gastrointestinal disease and that are available through mainstream laboratories in Australia.

Methods A comprehensive literature review was undertaken for each investigation, which was then evaluated on the basis of ACCE criteria for diagnostic tests. The ACCE criteria consider the analytical and clinical validity, clinical utility and ethical implications of the test.

Results Serum immunoglobulin G (IgG) to food antigens, salivary IgA, intestinal permeability, fecal short-chain fatty acids and fecal microbial analysis were identified as readily available. None of the investigations satisfied the ACCE criteria. The tests were deficient in one or more areas of analytical validity, clinical application, validity and ethical usage standards.

Conclusion Alternative investigations lack reliability and direct clinical applications, and should not be recommended for the investigation of gastrointestinal symptoms.

Introduction

Patients with irritable bowel syndrome frequently visit alternative medicine practitioners.[1] Aside from providing a variety of treatments, such as diet, phytotherapy and acupuncture, practitioners may offer their patients a range of alternative investigations (AIs). For the purpose of this review, AIs are defined as commercially available investigations that are marketed and provided by mainstream conventional diagnostic laboratories, and are used to support alternative medicine disease models. Many of these investigations appear to have their basis in medical research laboratories, but because of a lack of broader application or diagnostic utility, have subsequently been offered in the alternative arena. Both the popularity and availability of AIs appears to be increasing and, in many countries, individuals themselves may request these investigations directly via the internet. It is difficult to estimate the number of tests actually performed, although personal communication with the sales team of one major provider suggests that the number is "easily in the tens of thousands annually", and many of the tests cost between AU$50 and AU$200 (Genova Diagnostics NC, personal communication, 2011).

Given the expense and growing popularity of AIs, gastroenterologists and other physicians should be informed about and hence be capable of discussing these issues with their patients.

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