Solicit the patient's views about causes and triggers of symptomsĪsking open-ended questions (e.g., “Can you tell me what you think is causing your symptoms?” or “What do you think triggers your symptoms?”)Īsking closed-ended questions (e.g., “Do you think your pain is caused by eating?”)Īssess the patient's views on the connection between their symptoms and stressĮmphasizing that gastrointestinal abnormalities may disproportionately affect patients who are simultaneously experiencing stressful life events may be a more effective and acceptable starting point for discussionsįocusing on individuals with certain personality types who are susceptible to IBS may be less acceptable to patients Missing or failing to engage with cues and addressing only symptoms this may further somatization in patients I can see that the pain has affected your life.”)īe alert for empathic opportunities many patients provide cues to emotional or social problems acknowledge and address psychosocial concernsĭismissing symptoms (e.g., “There is nothing wrong with you.”) 7, 8Įvidence-based guidelines: evidence of benefit, but the evidence was low quality little or no data regarding long-term outcomes or harmsĮxpress empathy and be alert for psychosocial cuesĪcknowledging that the patient's explanations and symptoms are real ask how symptoms affect daily life (e.g., “I am sorry you are feeling this way. Gluten-free diets and low FODMAP diets should be instituted only for clear indications and under appropriate guidance from a dietitian. 7, 8, 35Ĭonsensus recommendation based on expert opinion and consistent evidence from qualitative patient surveys Initial interventions for IBS should focus on the most troublesome symptoms or their triggers and on improving quality of life. 13, 14, 24, 43Įvidence-based guidelines and retrospective evidence (favorable findings may also be related to a low pretest probability of organic disease in the populations studied) IBS can be diagnosed using symptom-based clinical criteria and limited testing in the absence of alarm features, exhaustive testing is not necessary. 2, 10 – 14Ĭonsensus recommendation based on consistent evidence from qualitative patient surveys This includes addressing patient concerns and expectations. Physicians can foster the continuous trusting relationships necessary for effective care of patients with IBS by sharing a clear diagnosis and responding appropriately to the diverse explanatory models used by patients. Trusting patient-physician interactions are essential to help patients understand and accept an IBS diagnosis and to actively engage in effective self-management. There is no definitive treatment for IBS, and recommended treatments focus on symptom relief and improved quality of life. Patients may not completely understand the diagnostic process asking about expectations and carefully explaining the goals and limitations of testing leads to more effective care. Patients who meet symptom-based criteria and have no alarm features may be confidently diagnosed with few, if any, additional tests. Patients in generally good health who have ongoing or recurrent gastrointestinal symptoms and abnormal stool patterns most likely have IBS or another functional gastrointestinal disorder. Anxiety related to the unpredictability of symptoms may have a greater effect on quality of life than the symptoms themselves. Physicians must understand the fears and expectations of patients and how they think about their symptoms and should also respond empathetically to psychosocial cues. Psychological factors do not cause IBS, but many people with IBS also have anxiety or depressed mood, a history of adverse life events, or psychosocial stressors. Irritable bowel syndrome (IBS) is a heterogeneous group of conditions related to specific biologic and cellular abnormalities that are not fully understood.
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