Author: American Family Physician
Family physicians frequently see patients who have abdominal pain and
altered bowel habits. It is a challenge to properly evaluate these patients
and differentiate between irritable bowel syndrome (IBS) and
life-threatening illnesses of the gastrointestinal tract.
IBS is one
of the most common chronic gastrointestinal illnesses. IBS traditionally has
been a diagnosis of exclusion, based on history, physical examination, and a
negative battery of diagnostic studies. There are no structural or chemical
markers for IBS. (1) Diagnostic tests are frequently overused because
physicians are concerned about missing a life-threatening illness. (2)
Epidemiology
Americans spend $8 billion each year on medical costs
related to IBS, (3) and absenteeism resulting from IBS significantly affects
the work force. Studies have shown that IBS affects 3 to 22 percent of
persons worldwide. (4) Symptoms are reported by 12 percent of Americans and
are the cause of 20 to 50 percent of referrals to gastroenterology clinics.
(5,6) Most people with IBS do not seek medical care. One half of patients
develop symptoms before 35 years of age, and 40 percent of patients develop
symptoms between 35 and 50 years of age. Onset in elderly persons is rare.
IBS is recognized in children, and many patients can trace their symptoms to
childhood. One study found that 26 percent of children with recurrent
abdominal pain were diagnosed with IBS, making it a common reason for school
absenteeism. (7) Seventy percent of patients with IBS are women; 48 to 79
percent of patients with chronic pelvic pain, dyspareunia, dysmenorrhea, or
a history of numerous abdominal surgeries also have IBS. (8) Women who have
had a hysterectomy for chronic pelvic pain are twice as likely to have IBS.
(2)
