Introduction Irritable bowel syndrome (IBS) patient care pathways are thought to vary, despite national clinical practice guidance in England. We present the findings of a multi-centre, observational, retrospective, cross-sectional, primary care research study to understand current patient pathways and quantify resource use.
Method Primary care records were screened for potential study patients using FARSITE software at 8 participating practices in Salford and Greater Manchester.1Search criteria: patients aged 18–60; combination of READ code symptoms indicative of IBS and prescription of IBS medications 01/01/2009–31/12/2011. Inclusion criteria: medical diagnosis of IBS by GP or meeting ROME III criteria. Exclusion Criteria: diagnosis excluding IBS; IBS symptoms secondary to other condition; IBS medications only for non-GI symptoms. Data collected from date of study eligibility (above) to date of data collection. Ethical approval ref. 13/LO/0692.
Results 97/297 (33%) eligible patients provided consent for participation. Patient characteristics are shown in Table 1. There were a mean (SD) of 1.4 (1.4) visits to primary care per patient/year overall (range 0–9.4); with 2.9 (2.4) visits in 1styear (n = 24) and 0.8 (2.0) visits in 2ndyear (n = 33) after first presentation with abdominal symptoms. Overall 58 (60%) patients had an investigation; 45 (46%) had a blood test, 24 (25%) imaging, 25 (26%) endoscopic investigation. There were 53 sary/tertiary care referrals for IBS management in 32 (33%) patients; 18 (19%) patients were referred once, 14 (14%) patients >1 occasions, mean (SD) 0.15 (0.24) per patient/year overall. 8/53 (15%) referrals were with the presence of a red flag symptom (s). 26/32 (81%) patients were referred to Gastroenterology, 15/32 (47%) to Radiology. The mean (SD) number of drug treatments per patient/year overall was 0.74 (0.60). 72 (74%) patients received anti-spasmodics, 44 (45%) laxatives, 14 (14%) antidiarrhoeals and 6 (6%) antidepressants (specifically for IBS). 53 (55%) patients received a medication unlicensed for IBS management.
Conclusion The ROME III criteria were inadequate for sub-typing 8% of patients, whose predominant presenting symptom was not constipation or diarrhoea. One in three patients was referred to secondary/tertiary care, the majority for non-red-flag symptoms; the appropriateness of these referrals warrants further investigation. Antispasmodics and laxatives were the most commonly prescribed medications, as expected. The use of antidepressants was less than anticipated although some may be receiving for depression. The high proportion of patients receiving unlicensed drugs suggests need for availability of licensed treatments specific for IBS.
Disclosure of interest I. Caldwell: None Declared, J. Collins: None Declared, R. Dew Consultant for: Employee of pH Associates, commissioned by Almirall to provide research design, conduct analysis and provide scientific editorial services., M. Rance Employee of: Employee of Almirall UK Limited.
Caldwell I, et al. Abstract PWE-165, BSG Conference 2014. Gut 2014;63(Suppl 1):A1–A288