Lacy Brian E, Rosemore Justin, Robertson Douglas, Corbin David A, Grau Maria, Crowell Michael D
Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
Scand J Gastroenterol. 2006 Aug;41(8):892-902. doi: 10.1080/00365520600554451.
Irritable bowel syndrome (IBS) is a common disorder characterized by abdominal discomfort and disordered bowel habits. Despite the high prevalence of IBS, little is known about how physicians perceive this condition. The aims of our study were to measure physicians' understanding of IBS, to assess their attitudes towards patients with IBS, and to determine whether there are differences in the way Internal Medicine physicians (IM), Family Practice physicians (FP), and Gastroenterology physicians (GI) evaluate and treat IBS patients.
A survey was sent to 3000 physicians nationwide, 1000 each to IM, FP, and GI. The survey contained 35 questions assessing demographics, the etiology and pathophysiology of IBS, the use of diagnostic tests, and practice patterns and attitudes.
Of the deliverable questionnaires, 501 were returned completed; 472 of the respondents interviewed only adult patients, representing the cohort for this analysis. The mean age of all respondents was 47; most were men (80%). IM and FP made a new diagnosis of IBS 1.3-1.6 times each week, while GI made a new diagnosis 5.4 times each week (p<0.0001). Compared with the perceptions of FP and IM, GI felt that IBS patients were less sick than other patients (p<0.001), although they required more time per visit. More GI compared with FP and IM stated that prior infection and a history of abuse were the causes of IBS (p<0.01), while FP were more likely to believe that diet was a cause of IBS (p<0.01). GI felt a new diagnosis of IBS could be made without further testing 42% of the time. FP and IM felt that one-third of IBS patients needed referral to a GI.
The attitudes and practice patterns of physicians towards patients with IBS differ depending on practice specialty. This may be due to differences in training, the ability to perform specialized tests, and/or differences in referral patterns. Further training may improve the ability of physicians in all specialties confidently to diagnose and treat patients with IBS.
肠易激综合征（IBS）是一种常见疾病，其特征为腹部不适和排便习惯紊乱。尽管IBS患病率很高，但医生对这种疾病的认知却知之甚少。我们研究的目的是衡量医生对IBS的了解程度，评估他们对IBS患者的态度，并确定内科医生（IM）、家庭医生（FP）和胃肠病医生（GI）在评估和治疗IBS患者的方式上是否存在差异。
向全国3000名医生发放了调查问卷，其中IM、FP和GI各1000名。该调查问卷包含35个问题，涉及人口统计学、IBS的病因和病理生理学、诊断测试的使用以及实践模式和态度。
在可投递的问卷中，有501份被完整返还；472名受访者仅诊治成年患者，这些受访者构成了本次分析的队列。所有受访者的平均年龄为47岁；大多数为男性（80%）。IM和FP每周分别做出1.3 - 1.6次IBS新诊断，而GI每周做出5.4次新诊断（p<0.0001）。与FP和IM的认知相比，GI认为IBS患者比其他患者病情轻（p<0.001），尽管他们每次就诊需要更多时间。与FP和IM相比，表示既往感染和虐待史是IBS病因的GI更多（p<0.01），而FP更倾向于认为饮食是IBS的病因（p<0.01）。GI认为42%的情况下无需进一步检查即可做出IBS新诊断。FP和IM认为三分之一的IBS患者需要转诊至GI。
医生对IBS患者的态度和实践模式因专业不同而存在差异。这可能是由于培训差异、进行专业检查的能力以及/或转诊模式的差异。进一步的培训可能会提高所有专业医生自信地诊断和治疗IBS患者的能力。
