Kelava I, Karabeg V, Špehar S Stojanović
Acta Med Croatica. 2015 Nov;69(4):245-52.
Diagnosing irritable bowel syndrome (IBS) is often a problem for general practitioners (GPs) because they rely on symptoms without specific biological markers. The objective was to examine the attitudes and knowledge of GPs in identifying and treating patients with IBS. The study included 51 GPs who take care of 87,000 patients, approximately 1,530 of them with IBS, on the basis of a questionnaire developed for this study in two health centers in Zagreb. The questionnaire contained questions with a case vignette on GP attitudes and knowledge about IBS. In comparison with other pain conditions, GPs were found to have least confidence and pleasure, while spending a lot of time and finding it most difficult to diagnose and treat patients suffering from IBS. In the case vignette, GPs answered correctly that it was IBS (84%) and most of them would give dietary advice and follow up the patient (67%). For the diagnosis of IBS, most physicians considered necessary to take diagnostic criteria into account, exclude alarming symptoms and do basic laboratory tests (39%). Most GPs considered IBS to be a functional bowel disorder (92%), 63% used diagnostic criteria for IBS, and 61% were familiar with the Rome III criteria for IBS. Gastroenterologists would be consulted by 53% of GPs in case of uncertain diagnosis and 35% of GPs for therapeutic inefficiency. In the treatment of IBS, most GPs (51%) prescribe pharmacotherapy for functional bowel disorders. The authors conclude that GPs showed great knowledge in recognizing and diagnosing IBS, but compared to other painful conditions they have little self-confidence and pleasure. They spend a lot of time and find it most difficult to diagnose and treat patients suffering from IBS. Additional education is needed with a more proactive approach in the form of workshops, which may bring change in their attitudes and improve their knowledge.
对于全科医生（GP）而言，诊断肠易激综合征（IBS）常常是个难题，因为他们依赖症状进行诊断，却没有特定的生物学标志物。本研究的目的是调查全科医生在识别和治疗IBS患者方面的态度和知识水平。该研究纳入了51名全科医生，他们在萨格勒布的两个健康中心负责照料87,000名患者，其中约1,530名患有IBS。研究依据为本研究专门设计的问卷展开。问卷包含了有关全科医生对IBS的态度和知识的病例 vignette 问题。与其他疼痛性疾病相比，全科医生对诊断和治疗IBS患者的信心和满意度最低，同时花费时间最多且认为这是最困难的。在病例 vignette 中，全科医生正确诊断出IBS的比例为84%，并且大多数人（67%）会给予饮食建议并对患者进行随访。对于IBS的诊断，大多数医生认为有必要考虑诊断标准、排除警示症状并进行基本实验室检查（39%）。大多数全科医生认为IBS是一种功能性肠病（92%），63%使用IBS的诊断标准，61%熟悉IBS的罗马III标准。在诊断不确定的情况下，53%的全科医生会咨询胃肠病专家，35%的全科医生因治疗效果不佳而咨询。在IBS的治疗中，大多数全科医生（51%）会为功能性肠病开药物治疗。作者得出结论，全科医生在识别和诊断IBS方面表现出了丰富的知识，但与其他疼痛性疾病相比，他们自信心和满意度较低。他们花费大量时间，并且发现诊断和治疗IBS患者最为困难。需要通过举办工作坊等更积极主动的方式进行额外培训，这可能会改变他们的态度并提高他们的知识水平。
