A protocol-driven assessment promotes a more accurate diagnosis of irritable bowel syndrome

Judith S. Moore, Peter R. Gibson, Richard E. Perry, Rebecca E. Burgell

Research output: Contribution to journalArticleResearchpeer-review

Abstract

A diverse range of conditions share symptoms commonly identified with irritable bowel syndrome. The objective of this study was to examine the diagnostic process in identifying additional diagnoses in women who are attending a clinic for evaluation of symptoms suggestive of irritable bowel syndrome. A retrospective audit was conducted of anonymous data gathered on consecutive female patients presenting to a specialist nurse-led service in Christchurch, New Zealand, with a provisional diagnosis of irritable bowel syndrome. A protocol containing routine pathology investigations and physical examination was used. Alarm features were identified and pertinent investigations were implemented. Rectocele was detected on rectal examination. Final diagnosis was noted and compared with baseline symptom data. Of 231 patients, 187 initially met Rome III criteria for irritable bowel syndrome. Red flags and abnormal investigations led to an alternate diagnosis in a further 27 patients. Of the 160 patients with irritable bowel syndrome, 31% were found to have a rectocele. They were seven times more likely to report a symptom associated with pelvic floor dysfunction (p <.0001) and four times more likely to report constipation (p =.0003). The use of a protocol including routine investigations and physical examination improves diagnostic yield. Pelvic floor dysfunction should be considered in those with unique symptom patterns and rectocele in the setting of irritable bowel syndrome.

Original languageEnglish
Pages (from-to)508-515
Number of pages8
JournalGastroenterology Nursing
Volume41
Issue number6
DOIs
Publication statusPublished - 1 Nov 2018

Cite this

@article{77e50ebfc21240da8cfdb470829cdbe8,
title = "A protocol-driven assessment promotes a more accurate diagnosis of irritable bowel syndrome",
abstract = "A diverse range of conditions share symptoms commonly identified with irritable bowel syndrome. The objective of this study was to examine the diagnostic process in identifying additional diagnoses in women who are attending a clinic for evaluation of symptoms suggestive of irritable bowel syndrome. A retrospective audit was conducted of anonymous data gathered on consecutive female patients presenting to a specialist nurse-led service in Christchurch, New Zealand, with a provisional diagnosis of irritable bowel syndrome. A protocol containing routine pathology investigations and physical examination was used. Alarm features were identified and pertinent investigations were implemented. Rectocele was detected on rectal examination. Final diagnosis was noted and compared with baseline symptom data. Of 231 patients, 187 initially met Rome III criteria for irritable bowel syndrome. Red flags and abnormal investigations led to an alternate diagnosis in a further 27 patients. Of the 160 patients with irritable bowel syndrome, 31{\%} were found to have a rectocele. They were seven times more likely to report a symptom associated with pelvic floor dysfunction (p <.0001) and four times more likely to report constipation (p =.0003). The use of a protocol including routine investigations and physical examination improves diagnostic yield. Pelvic floor dysfunction should be considered in those with unique symptom patterns and rectocele in the setting of irritable bowel syndrome.",
author = "Moore, {Judith S.} and Gibson, {Peter R.} and Perry, {Richard E.} and Burgell, {Rebecca E.}",
year = "2018",
month = "11",
day = "1",
doi = "10.1097/SGA.0000000000000349",
language = "English",
volume = "41",
pages = "508--515",
journal = "Gastroenterology Nursing",
issn = "1042-895X",
publisher = "Lippincott Williams & Wilkins",
number = "6",

}

A protocol-driven assessment promotes a more accurate diagnosis of irritable bowel syndrome. / Moore, Judith S.; Gibson, Peter R.; Perry, Richard E.; Burgell, Rebecca E.

In: Gastroenterology Nursing, Vol. 41, No. 6, 01.11.2018, p. 508-515.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A protocol-driven assessment promotes a more accurate diagnosis of irritable bowel syndrome

AU - Moore, Judith S.

AU - Gibson, Peter R.

AU - Perry, Richard E.

AU - Burgell, Rebecca E.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - A diverse range of conditions share symptoms commonly identified with irritable bowel syndrome. The objective of this study was to examine the diagnostic process in identifying additional diagnoses in women who are attending a clinic for evaluation of symptoms suggestive of irritable bowel syndrome. A retrospective audit was conducted of anonymous data gathered on consecutive female patients presenting to a specialist nurse-led service in Christchurch, New Zealand, with a provisional diagnosis of irritable bowel syndrome. A protocol containing routine pathology investigations and physical examination was used. Alarm features were identified and pertinent investigations were implemented. Rectocele was detected on rectal examination. Final diagnosis was noted and compared with baseline symptom data. Of 231 patients, 187 initially met Rome III criteria for irritable bowel syndrome. Red flags and abnormal investigations led to an alternate diagnosis in a further 27 patients. Of the 160 patients with irritable bowel syndrome, 31% were found to have a rectocele. They were seven times more likely to report a symptom associated with pelvic floor dysfunction (p <.0001) and four times more likely to report constipation (p =.0003). The use of a protocol including routine investigations and physical examination improves diagnostic yield. Pelvic floor dysfunction should be considered in those with unique symptom patterns and rectocele in the setting of irritable bowel syndrome.

AB - A diverse range of conditions share symptoms commonly identified with irritable bowel syndrome. The objective of this study was to examine the diagnostic process in identifying additional diagnoses in women who are attending a clinic for evaluation of symptoms suggestive of irritable bowel syndrome. A retrospective audit was conducted of anonymous data gathered on consecutive female patients presenting to a specialist nurse-led service in Christchurch, New Zealand, with a provisional diagnosis of irritable bowel syndrome. A protocol containing routine pathology investigations and physical examination was used. Alarm features were identified and pertinent investigations were implemented. Rectocele was detected on rectal examination. Final diagnosis was noted and compared with baseline symptom data. Of 231 patients, 187 initially met Rome III criteria for irritable bowel syndrome. Red flags and abnormal investigations led to an alternate diagnosis in a further 27 patients. Of the 160 patients with irritable bowel syndrome, 31% were found to have a rectocele. They were seven times more likely to report a symptom associated with pelvic floor dysfunction (p <.0001) and four times more likely to report constipation (p =.0003). The use of a protocol including routine investigations and physical examination improves diagnostic yield. Pelvic floor dysfunction should be considered in those with unique symptom patterns and rectocele in the setting of irritable bowel syndrome.

UR - http://www.scopus.com/inward/record.url?scp=85057540754&partnerID=8YFLogxK

U2 - 10.1097/SGA.0000000000000349

DO - 10.1097/SGA.0000000000000349

M3 - Article

VL - 41

SP - 508

EP - 515

JO - Gastroenterology Nursing

JF - Gastroenterology Nursing

SN - 1042-895X

IS - 6

ER -