Yawn B P, Lydick E, Locke G R, Wollan P C, Bertram S L, Kurland M J
Department of Research, Olmsted Medical Center, Rochester, Minnesota, USA.
BMC Gastroenterol. 2001;1:11. doi: 10.1186/1471-230x-1-11. Epub 2001 Oct 26.
The only US guidelines listed in the National Guideline Warehouse for the diagnosis of Irritable Bowel Syndrome (IBS) are the expert opinion guidelines published by The American Gastroenterology Association. Although the listed target audience of these guidelines includes family physicians and general internists, the care recommended in the guidelines has not been compared to actual primary care practice. This study was designed to compare expert opinion guidelines with the actual primary care provided and to assess outcomes in the 3 years following the IBS diagnosis.
This is a retrospective medical record review study using a random sample of incident IBS cases from all Olmsted County, Minnesota providers diagnosed between January 1, 1993 and December 31, 1995. Data was collected on all care and testing provided to the subjects as well as 3-year outcomes related to the IBS diagnosis.
Of the 149 IBS patients, 99 were women and the mean age was 47.6 years. No patient had all of the diagnostic tests recommended in the guidelines. 42% had the basic blood tests of CBC and a chemistry panel. Sedimentation rate (2%) and serum thyroxine level (3%) were uncommon. Colon imaging studies were done in 41% including 74% of those over the age of 50. In the 3 years following the diagnosis, only one person had a change in diagnosis and no diagnoses of gastro-intestinal malignancies were made in the cohort.
Primary care practice based diagnostic evaluations for IBS differ significantly from the specialty expert opinion-based guidelines. Implementation of the specialty guidelines in primary care practice would increase utilization with apparent limited improvement in diagnostic outcomes.
国家指南库中列出的用于诊断肠易激综合征（IBS）的唯一美国指南是美国胃肠病学会发布的专家意见指南。尽管这些指南列出的目标受众包括家庭医生和普通内科医生，但指南中推荐的护理措施尚未与实际的初级保健实践进行比较。本研究旨在将专家意见指南与实际提供的初级保健进行比较，并评估IBS诊断后3年的结果。
这是一项回顾性病历审查研究，使用了1993年1月1日至1995年12月31日期间明尼苏达州奥尔姆斯特德县所有提供者诊断出的IBS新发病例的随机样本。收集了提供给受试者的所有护理和检测数据以及与IBS诊断相关的3年结果。
149例IBS患者中，99例为女性，平均年龄为47.6岁。没有患者进行了指南中推荐的所有诊断测试。42%的患者进行了血常规和生化检查等基本血液检测。血沉（2%）和血清甲状腺素水平（3%）检测不常见。41%的患者进行了结肠成像检查，其中50岁以上患者的这一比例为74%。在诊断后的3年里，队列中只有1人诊断发生了变化，且未诊断出胃肠道恶性肿瘤。
基于初级保健实践的IBS诊断评估与基于专科专家意见的指南有显著差异。在初级保健实践中实施专科指南会增加医疗服务的使用，但诊断结果的改善似乎有限。
