title: Therapeutic value of a gastroenterology consultation in irritable bowel syndrome.
abstract: BACKGROUND
  Functional patients comprise the largest group in gastroenterology practice. Pharmacological therapy of irritable bowel syndrome is disappointing. One treatment strategy for irritable bowel syndrome emphasizes the physician's role; the physician is promoted as the therapeutic modality.
  
  
  OBJECTIVE
  To determine the therapeutic value of the contemporary approach to irritable bowel syndrome by examining health care utilization and patient morbidity.
  
  
  METHODS
  We performed an observational study over 4 years using an administrative database and morbidity scales. Health care utilization was assessed for 2 years pre- and post-intervention. Patient morbidity was assessed at baseline and 1 and 2 years post-intervention. The participants included 70 irritable bowel syndrome patients referred by primary physicians. A structured consultation was performed, establishing a positive diagnosis of irritable bowel syndrome and providing disease conceptualization.
  
  
  RESULTS
  Health care utilization for gastrointestinal diagnoses increased in the year prior to the intervention and declined immediately after to baseline; psychiatric and other visits remained unchanged for 4 years. Pain was reduced but other morbidity persisted.
  
  
  CONCLUSIONS
  A consultation itself is a therapeutic intervention in irritable bowel syndrome with regard to its impact on societal economic burden. It is associated with a durable decrease in illness-specific health care utilization. It may not address all aspects of irritable bowel syndrome; multiple domains of morbidity demonstrated persistent distress.
authors.affiliation: Departments of Internal Medicine and Clinical Health Psychology, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. ailnycky@mail.sbgh.mb.ca
authors.forename: A
authors.initials: A
authors.lastname: Ilnyckyj
authors.forename: L A
authors.initials: LA
authors.lastname: Graff
authors.forename: J F
authors.initials: JF
authors.lastname: Blanchard
authors.forename: C N
authors.initials: CN
authors.lastname: Bernstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003109:Colonic Diseases, Functional / Q000628:therapy*; D005260:Female; D005762:Gastroenterology; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000209:etiology; D012017:Referral and Consultation