Natural History of Irritable Bowel Syndrome
Background: The natural history of irritable bowel syndrome is unclear, including the likelihood that these patients will be diagnosed with an alternative organic or functional gastrointestinal disorder. Understanding the stability of an irritable bowel syndrome diagnosis may limit repeated diagnostic evaluation among these patients.
Methods: The inclusion criteria included observational longitudinal studies of clinic-based samples of adult patients with irritable bowel syndrome. Only studies published in the English language in full manuscript form were included. Literature searches, selection and review of eligible articles, and data abstraction were performed in a duplicate, independent manner.
Results: Fourteen studies met study selection criteria. In six studies with relevant information, 2-5% of irritable bowel syndrome patients were diagnosed with an alternative organic GI disorder after 6 months to 6 years of follow-up. Long-term follow-up indicated that 2-18% of patients developed worse irritable bowel syndrome symptoms, approximately 30-50% of patients had unchanged symptoms, and the rest either improved or had symptoms disappear. Prior surgery (one study), higher somatic scores (one study), higher baseline anxiety (two studies), depression scores (one study) were predictive of worsening of symptoms during long-term follow-up.
Conclusions: Irritable bowel syndrome, a chronic disorder, is a stable diagnosis. Once initial investigations are negative, fewer than 5% are diagnosed with an alternative organic GI disorder. Repeated diagnostic evaluations of patients with recurrent or persistent symptoms similar to their baseline symptoms are not warranted.
Irritable bowel syndrome (IBS) is a chronic relapsing condition that is diagnosed with symptom-based criteria. Most patients with IBS undergo exhaustive diagnostic evaluations to rule out other organic GI disorders before physicians and/or patients accept this diagnosis. The natural history of IBS has been described as a chronic course with intermittent flares. Thus, this natural history lends itself to repeated diagnostic evaluations at considerable expense while exposing the patient to procedure-related complications.
The natural history of IBS, including the stability of a symptom-based IBS diagnosis and the frequency and duration of symptomatic IBS flares, is poorly documented. Previous studies estimate the likelihood of diagnosing an alternative organic GI disorder during prolonged follow-up of IBS patients. Previous studies also suggest that some patients with IBS transition into other functional GI disorders. In order to minimize repeated expensive and potentially morbid diagnostic evaluations in these patients, it is important to determine the stability of an IBS diagnosis and the frequency that IBS transitions to alternative functional GI disorders. Therefore, knowledge of the natural history of IBS is relevant to primary care providers, gastroenterologists and health care policy makers. Although a previous systematic review discussed the clinical course and prognostic determinants of IBS, it did not provide a detailed account of the stability of an IBS diagnosis, the frequency of transition to alternative functional GI disorders, or the frequency and duration of symptomatic IBS flares. The current report provides an updated systematic review with new publications and with a detailed evaluation of the natural history of IBS.
Therefore, this systematic review of published literature encompasses the following objectives: (i) to determine the stability of the IBS diagnosis (i.e. to determine the likelihood that an alternative organic GI disorder would be diagnosed after an initial diagnosis of IBS); (ii) to determine the likelihood that IBS patients would transition to alternative functional GI disorders; (iii) to characterize the frequency and duration of symptomatic flares of IBS; (iv) to identify limitations in the current research; and (v) to identify areas for future research.
Background: The natural history of irritable bowel syndrome is unclear, including the likelihood that these patients will be diagnosed with an alternative organic or functional gastrointestinal disorder. Understanding the stability of an irritable bowel syndrome diagnosis may limit repeated diagnostic evaluation among these patients.
Methods: The inclusion criteria included observational longitudinal studies of clinic-based samples of adult patients with irritable bowel syndrome. Only studies published in the English language in full manuscript form were included. Literature searches, selection and review of eligible articles, and data abstraction were performed in a duplicate, independent manner.
Results: Fourteen studies met study selection criteria. In six studies with relevant information, 2-5% of irritable bowel syndrome patients were diagnosed with an alternative organic GI disorder after 6 months to 6 years of follow-up. Long-term follow-up indicated that 2-18% of patients developed worse irritable bowel syndrome symptoms, approximately 30-50% of patients had unchanged symptoms, and the rest either improved or had symptoms disappear. Prior surgery (one study), higher somatic scores (one study), higher baseline anxiety (two studies), depression scores (one study) were predictive of worsening of symptoms during long-term follow-up.
Conclusions: Irritable bowel syndrome, a chronic disorder, is a stable diagnosis. Once initial investigations are negative, fewer than 5% are diagnosed with an alternative organic GI disorder. Repeated diagnostic evaluations of patients with recurrent or persistent symptoms similar to their baseline symptoms are not warranted.
Irritable bowel syndrome (IBS) is a chronic relapsing condition that is diagnosed with symptom-based criteria. Most patients with IBS undergo exhaustive diagnostic evaluations to rule out other organic GI disorders before physicians and/or patients accept this diagnosis. The natural history of IBS has been described as a chronic course with intermittent flares. Thus, this natural history lends itself to repeated diagnostic evaluations at considerable expense while exposing the patient to procedure-related complications.
The natural history of IBS, including the stability of a symptom-based IBS diagnosis and the frequency and duration of symptomatic IBS flares, is poorly documented. Previous studies estimate the likelihood of diagnosing an alternative organic GI disorder during prolonged follow-up of IBS patients. Previous studies also suggest that some patients with IBS transition into other functional GI disorders. In order to minimize repeated expensive and potentially morbid diagnostic evaluations in these patients, it is important to determine the stability of an IBS diagnosis and the frequency that IBS transitions to alternative functional GI disorders. Therefore, knowledge of the natural history of IBS is relevant to primary care providers, gastroenterologists and health care policy makers. Although a previous systematic review discussed the clinical course and prognostic determinants of IBS, it did not provide a detailed account of the stability of an IBS diagnosis, the frequency of transition to alternative functional GI disorders, or the frequency and duration of symptomatic IBS flares. The current report provides an updated systematic review with new publications and with a detailed evaluation of the natural history of IBS.
Therefore, this systematic review of published literature encompasses the following objectives: (i) to determine the stability of the IBS diagnosis (i.e. to determine the likelihood that an alternative organic GI disorder would be diagnosed after an initial diagnosis of IBS); (ii) to determine the likelihood that IBS patients would transition to alternative functional GI disorders; (iii) to characterize the frequency and duration of symptomatic flares of IBS; (iv) to identify limitations in the current research; and (v) to identify areas for future research.
SHARE
