Introduction NICE guidance recommends that patients presenting with symptoms suggestive of the irritable bowel syndrome (IBS) should be tested for coeliac disease (CD). This study reviewed the symptoms, demographics and investigation of pateints diagnosed with IBS at a large semi-rural general practice.
Methods Patients diagnosed with the IBS were identified from a computer database of 11,250 patients at St Johns Surgery. 250 casenotes were randomly selected for analysis. Patient demographics, symptoms recorded and investigations performed were recorded. a history of depression was recorded. Census and postcode data was used as a surogate marker of poverty.
Results 499 patients had a diagnosis of IBS (110 male and 389 females). The records of 48 male and 202 female patients were reviewed.
186 patients were diagnosed with IBS within 6 months of their initial consultation. 180 began treatment for IBS within 6 months of diagnosis.
65 patients were tested for CD (13 males and 52 females). 34 (52%) of those tested for CD went on to have further investigations such as a barium enema or colonoscopy.185 patients were not tested for CD. 137 had no further investigations.
Symptoms of those tested for CD were a change in bowel habit (90.8%), abdominal pain (90.8%), chronic diarrhoea (73.8%) and bloating (67.7%). Symptoms of those not tested for CD were the most common symptoms where abdominal pain (91.9%), change in bowel habit (73.5%) and bloating (69.2%) and chronic diarrhoea (52.4%).
There was no significant difference in poverty or history of depression between those tested and not tested for CD.
Conclusion This study suggests that patients diagnosed with the IBS in primary care are not routinely tested for CD. Explanations include a pragmatic approach to investigation of common gastrointestinal symptoms and a likely difference between patients diagnosed with the IBS in primary care and those referred onto secondary care and academic centres.
References National Institute for Health and Clinical Excellence. 2009. Recognition and Assessment of Coeliac Disease
National Institute for Health and Clinical Excellence. 2008. Irritable bowel syndrome in adults
Disclosure of Interest None Declared.