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Mistakes in irritable bowel syndrome and how to avoid them


Jeffrey Roberts
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Jeffrey Roberts

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Mistakes in irritable bowel syndrome and how to avoid them

September 21, 2016 | By: Robin Spiller

Around 11% of the worldwide population experience irritable bowel syndrome (IBS), making it one of the most frequent gastroenterological diagnoses.1 The symptoms of IBS include abdominal pain associated with unpredictable bowel habits and variable changes in the form and frequency of stool.2

While all patients with IBS suffer from recurrent bouts of abdominal pain, their bowel habits are varied: around one-third suffer predominantly with diarrhoea (IBS-D), one-fifth experience predominantly constipation (IBS-C) and half have an erratic mixed pattern of both diarrhoea and constipation (IBS-M).3This very heterogeneous condition undoubtedly has multiple causes and an individualized approach to management and treatment is required.

Here I discuss the mistakes most frequently made when diagnosing and managing IBS. The mistakes and discussion that follow are based, where possible, on published data and failing that on many years of my own clinical experience.

 

Mistake 1 | Failing to detect bile salt malabsorption

 

Mistake 2 | Failing to recognize somatization, leading to multiple referrals to non-gastrointestinal specialists

 

Mistake 3 | Not telling the patient that they have a high probability of having IBS at the onset of investigation

 

Mistake 4 | Failing to recognize the key features of bloating, leading to multiple negative investigations including CT and ultrasound

 

Mistake 5 | Using opiates to control IBS pain

 

Mistake 6 | Misdiagnosing Crohn’s disease as IBS-D

 

Mistake 7 | Performing cholecystectomy for right upper quadrant pain without gallstones

 

Mistake 8 | Performing a hysterectomy/laparoscopy and division of adhesions for IBS pain

 

Mistake 9 | Testing for lactose intolerance when a patient consumes <240ml of milk or its equivalent per day

 

Mistake 10 | Encouraging food exclusion without reinforcing the need to reintroduce foods to confirm apparent intolerance, leading to ever more restricted diets and malnutrition

 

© UEG 2016 Spiller.

Reference: Spiller R. Mistakes in irritable bowel syndrome and how to avoid them. UEG Education 2016: 16; 31–33.



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