 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 January 1995 | Volume 122 Issue 2 | Pages 107-112
Objective: To evaluate the long-term course and prognosis associated with the irritable bowel syndrome (IBS) and to determine the influence of an effective physician-patient relationship on subsequent health care use.
Design: Prospective review of medical records.
Setting: Tertiary referral center.
Patients: 112 consecutive Olmsted County, Minnesota, residents who were first diagnosed with IBS at the Mayo Clinic during the period 1961-1963.
Results: The median follow-up was 29 years (range, 1 to 32 years) and patients made a median of 2 return visits for IBS-related symptoms (range, 0 to 12 visits). In addition to abdominal pain, diarrhea (reported by 50% of patients) was the predominant bowel symptom at diagnosis. Organic gastrointestinal disease occurred in 10 patients a median of 15 years after diagnosis of IBS. Survival in patients with IBS did not differ from expected survival (27 deaths; median survival > 30 years after initial diagnosis). A positive physician-patient interaction, defined a priori using objective criteria in the written record, was associated with fewer return visits for IBS. Of the eight variables examined, notations in the medical record about psychosocial history, precipitating factors, and discussion of diagnosis and treatment with patients were associated with fewer return visits for IBS-related symptoms.
Conclusions: When diagnosed according to current criteria, IBS is associated with a good prognosis and the diagnosis is unlikely to be changed to that of an organic disease during follow-up. A positive physician-patient interaction may be related to reduced use of ambulatory health services by patients with IBS.
Author and Article Information
From the Mayo Clinic and Foundation, Rochester, Minnesota.
ARTICLE
The Irritable Bowel Syndrome: Long-Term Prognosis and the Physician-Patient Interaction
Requests for Reprints: Daniel K. Nelson, MS, Director of Research, Isaac Gordon Center, Genesee Hospital, University of Rochester, 224 Alexander Street, Rochester, NY 14607.
Acknowledgments: The authors thank Alan R. Zinsmeister for assistance with the survival analysis; Kathleen L. Geisler and Joel B. Worra for computer consultation; Michael J. Ford for critical review; Vel R. Woyczik and Lois A. Law for manuscript preparation; and Richard M. Zaner, Volney P. Gay, Liston O. Mills, Christopher D. Lind, and James H. Hogge of Vanderbilt University for helpful suggestions.
Grant Support: In part by RO1 grant AG09440 from the National Institutes of Health.
This article has been cited by other articles:
|
|
 |
|
  T. J Kaptchuk, J. M Kelley, L. A Conboy, R. B Davis, C. E Kerr, E. E Jacobson, I. Kirsch, R. N Schyner, B. H. Nam, L. T Nguyen, et al. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome BMJ, May 3, 2008; 336(7651): 999 - 1003. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Spiller, Q Aziz, F Creed, A Emmanuel, L Houghton, P Hungin, R Jones, D Kumar, G Rubin, N Trudgill, et al. Guidelines on the irritable bowel syndrome: mechanisms and practical management Gut, December 1, 2007; 56(12): 1770 - 1798. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Lembo A 54-Year-Old Woman With Constipation-Predominant Irritable Bowel Syndrome JAMA, February 22, 2006; 295(8): 925 - 933. [Full Text] [PDF]
|
|
|
|
|
|
T. Kennedy, R. Jones, S. Darnley, P. Seed, S. Wessely, and T. Chalder Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial BMJ, August 20, 2005; 331(7514): 435. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. R. Mertz Irritable Bowel Syndrome N. Engl. J. Med., November 27, 2003; 349(22): 2136 - 2146. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Cremonini and N. J Talley Psychotherapy or paroxetine did not reduce abdominal pain, but may improve quality of life in irritable bowel syndrome Evid. Based Med., September 1, 2003; 8(5): 160 - 160. [Full Text] [PDF]
|
|
|
|
 |
|
 L A Page and S Wessely Medically unexplained symptoms: exacerbating factors in the doctor-patient encounter J R Soc Med, May 1, 2003; 96(5): 223 - 227. [Full Text] [PDF]
|
|
|
|
|
|
W Grant Thompson Tegaserod and IBS: a perfect match? Gut, May 1, 2003; 52(5): 621 - 622. [Full Text]
|
|
|
|
 |
|
 M C Gunn, A A Cavin, and J C Mansfield Management of irritable bowel syndrome Postgrad. Med. J., March 1, 2003; 79(929): 154 - 158. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Jailwala, T. F. Imperiale, and K. Kroenke Pharmacologic Treatment of the Irritable Bowel Syndrome: A Systematic Review of Randomized, Controlled Trials Ann Intern Med, July 18, 2000; 133(2): 136 - 147. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Dixon-Woods and S. Critchley Medical and lay views of irritable bowel syndrome Fam. Pract., April 1, 2000; 17(2): 108 - 113. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. L. Goldenberg Fibromyalgia Syndrome a Decade Later: What Have We Learned? Arch Intern Med, April 26, 1999; 159(8): 777 - 785. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. H. Griffith III, J. F. Wilson, and E. C. Rich A Randomized Trial of Providing House Staff with Patient Social History Information: Effect on Patient Outcomes Eval Health Prof, September 1, 1998; 21(3): 362 - 376. [Abstract] [PDF]
|
|
|
|
 |
|
 THE COURSE OF IRRITABLE BOWEL SYNDROME Journal Watch (General), January 31, 1995; 1995(131): 5 - 5. [Full Text]
|
|
Article
