The Irritable Bowel Syndrome: Long-Term Prognosis and the Physician-Patient Interaction

doi:10.1059/0003-4819-122-2-199501150-00005

The Irritable Bowel Syndrome: Long-Term Prognosis and the Physician-Patient Interaction

From the Mayo Clinic and Foundation, Rochester, Minnesota. 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.

Abstract

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.