Irritable bowel syndrome: Not the clinical burden it used to be

Amanda Lyons

23/01/2018 3:13:40 PM

A traditionally difficult condition, irritable bowel syndrome has become easier to diagnose and manage in general practice.

Irritable bowel syndrome can now most often be identified by GPs with a clinical history and a physical exam.
Irritable bowel syndrome can now most often be identified by GPs with a clinical history and a physical exam.

Irritable bowel syndrome, or IBS, is a very prevalent condition that affects 10% of the Australian population at any point in time. It is thus very likely that GPs will have regular contact with patients experiencing it.
Diagnosing IBS used to involve a long and difficult process of exclusion, but this has changed over recent years. The condition can now usually be identified by GPs with a clinical history and a physical examination.
‘Most of the clinical assessment involves checking in for alarm features and high-risk family history, very simple tests like a blood count, maybe some iron studies and a little poo-pot test called the faecal calprotectin, and a rectal exam so that nothing serious in the rectal area is missed,’ Professor Jane Andrews, a gastroenterologist and Clinical Professor at the School of Medicine, University of Adelaide, told newsGP.
Professor Andrews acknowledges that, despite its prevalence, IBS is certainly not considered a ‘sexy’ condition.
‘People feel that bowel issues are a stigmatising problem, so they don’t talk about them in the same way [as other conditions]. They hide it,’ she said.
In addition to the delicate nature of raising the issue, it has been hard for IBS to shake free of its long-held difficult reputation in the medical community, where many have considered it problematic to diagnose and treat.
‘In the past, there was a lot of frustration and what we call “therapeutic nihilism”, where patients and doctors felt that no-one could do anything, so why bother,’ Professor Andrews said. ‘There’s also a bit of concrete thinking; as in, people think someone’s got a symptom, there must be something we can see.
‘We all understand that you can have a headache, but a brain scan will be normal; or you can have a backache, while an X-ray of the back will be fine. But people often don’t accept or understand that you can have a sore or a sensitive gut without the need for a colonoscopy.’
This so-called ‘therapeutic nihilism’ can lead patients to a frustrating round of inconclusive investigations without a diagnosis, the stress of which can, in turn, exacerbate symptoms.
‘The best thing we can do from a medical point of view is to make an early diagnosis for people before they get stuck in a rut,’ Professor Andrews said.
Once a diagnosis is made, the next step is to educate the patient about the nature of IBS and its management. While drug therapies are available, Professor Andrews believes that non-drug options, such as a low-FODMAP diet or sessions with a psychologist to manage anxiety and stress, are generally most effective because IBS is a condition that most patients have to manage on a lifelong basis.
The advances in IBS diagnosis and management mean that most patients today won’t need to progress their treatment any further than consults with their GP; according to Professor Andrews, only 10–20% of patients will need specialist input. This makes GPs a crucial part of managing IBS, so she wants to encourage them that there is cause to feel much more optimistic about the condition than they may have in the past.
‘IBS is now a much more rewarding condition to deal with than it used to be,’ Professor Andrews said. ‘It shouldn’t be a negative experience anymore.’

IBS irritable-bowel-syndrome

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Chris Hogan   25/01/2018 8:43:48 PM

Is calprotectin test now reimbursed by Medicare?

Professor Jane Andrews   29/01/2018 10:03:00 AM

Thanks for your question, Chris.
No, calprotectin is not currently funded under the MBS. It is currently under review by Medical Services Advisory Committee (MSAC) to consider funding it.

Patrice Callaghan   9/02/2018 8:07:37 AM

Are sacral n stimulators available in the public system to help with ibs and faecal incontinence? I work with a surgeon who puts them in in the private sector and they are amazing if they do well on the trial

Dr Sinnappu Sivacolundhu   9/10/2019 2:02:22 PM

I am now completely retired and not seeing any patients at all. I never liked to use the term "Irritable Bowel". We used it when we could not give a definite diagnosis otherwise!! I always tried a course of Metronidazole for a week or two; and found that it works often; but not always. If it works why not repeat it prn!! I know many learned GPs will disagree with what I have written --- but if it helps even a few, whu not try it!! --