Introduction The confident diagnosis of chronic abdominal conditions can be challenging. This study assessed the diagnostic process in irritable bowel syndrome with constipation (IBS‑C), irritable bowel syndrome with diarrhoea (IBS‑D), inflammatory bowel disease (IBD) and chronic constipation (CC).
Methods Online interviews were conducted with 25 experts, 100 gastroenterologists (GEs) and 104 general practitioners (GPs) from Germany, Spain, France, Italy and the United Kingdom to explore perception, attitude and diagnostic approach to IBS. Physicians were also presented patient vignettes describing a typical case of IBS-C, IBS-D, IBD and CC, respectively. For each vignette, participants were asked to make a diagnosis and to give details on further clinical investigations and management of each case.
Results The CC and IBS-C vignettes caused most diagnostic difficulties. For the IBS-C vignette, most GEs and GPs who did not make a correct diagnosis were unsure of the diagnosis. In contrast, most physicians who did not make a correct diagnosis for the CC vignette gave an incorrect diagnosis of IBS-C.
Physicians’ confidence level in their diagnosis was 7.0/9 for the IBS-D vignette, 6.8/9 for IBS-C and 6.7/9 for CC. The score was lowest for IBD (6.3) as most physicians stated they would wait for the results of further investigations prior to diagnosis. Experts were most likely to endorse a positive approach to the diagnosis of IBS, IBD or CC, whereas GEs and GPs preferred to adopt a diagnosis by exclusion approach. For the IBS and CC vignettes, most physicians’ next action would be to prescribe treatment. However, for the IBD vignette, the next action would be to conduct tests. Most experts (96%) and GEs (73%) claimed to have a good knowledge of the Rome III diagnostic criteria, compared to only 15% of GPs.
Conclusion The study highlights some of the difficulties experienced by GPs, GEs and experts in diagnosing chronic abdominal conditions. Physicians found differentiating between IBS-C and CC to be particularly challenging. Diagnostic criteria designed for research purposes may not necessarily be applicable in standard clinical practice.
Study funded by Almirall S. A.
Disclosure of Interest V. Andresen Consultant for: Almirall, Astra Zeneca, Norgine, Shire, Conflict with: Almirall, Abbvie, Aptalis, Ardeypharm, Norgine, Shire, Mundipharma, Falk, P. Whorwell: None Declared, J. Fortea Employee of: Almirall S. A., J. Milce Grant/research support from: Almirall, Consultant for: Kantar Health.