IRRITABLE BOWEL SYNDROME - 06/09/11
Résumé |
Irritable bowel syndrome (IBS) is the most common functional disorder of the gastrointestinal tract. As a result of the lack of specific diagnostic testing and absence of circumscribed biologic markers of disease, the diagnosis is based on a constellation of symptoms. In an attempt to standardize the definition of disease, an international consensus group formalized clinical parameters based on data from Manning et al40 for a symptom-based diagnosis. In reference to the location of the meeting, these criterion have been termed the Rome criteria and subsequently have been refined further (see the accompanying box).59 At present, because of incomplete understanding of the pathophysiology of IBS, patient subsets are defined by their predominant symptom (Figure 1).
Rome Criteria of Irritable Bowel Syndrome
• | Continuous or recurrent symptoms of:
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• | Two or more of the following, for at least a quarter of occasions or days:
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Symptoms of IBS have afflicted humans since antiquity. Maimonides advised that humans should strive to have their intestines relaxed all the days of their lives. IBS is a common disorder affecting approximately 15% of the population.1 One third seek medical attention from their primary physician, and 10% to 15% are referred to a gastroenterologist.47 Based on the large portion of the population affected, the societal costs of the disease are immense. Physician visits total approximately 3.5 million a year, and medications are prescribed for most patients, averaging 2.2 million prescriptions a year.19, 23 In a comparative study in 1992 dollars, office-based costs averaged $742 per IBS patient compared with $429 for nonpatients.57 Pharmacologic costs are significantly greater in IBS patients.14 Patients with IBS have a greater likelihood of suffering other medical and gastrointestinal problems.43 For example, functional dyspepsia occurs in more than one third of IBS sufferers.56 Patients with IBS are more likely to undergo surgery, including hysterectomies and appendectomies, and are more apt to have had multiple operations.38 Evaluation and treatment of associated disorders and the greater tendency for additional surgery inflate health care costs further.
Indirect costs are more difficult to calculate but appear substantial. In one study, absenteeism over 1 year averaged 13.4 days for patients with IBS compared with 4.0 days for controls. The diagnosis and treatment of IBS and its associated problems account for billions of health care dollars.
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| Address reprint requests to Robin D. Rothstein, MD, Division of Gastroenterology, Pennsylvania Hospital, University of Pennsylvania Health System, Spruce Building, 9th Floor, 8th and Spruce Streets, Philadelphia, PA 19107 |
Vol 84 - N° 5
P. 1247-1257 - septembre 2000 Retour au numéro
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