title: The usual medical care for irritable bowel syndrome.
abstract: OBJECTIVE
  To determine what constitutes usual medical care for irritable bowel syndrome, which patient characteristics influence choice of treatment and how satisfied patients are with care.
  
  
  METHODS
  Patient encounters in a health maintenance organization were prospectively monitored to identify visits coded irritable bowel syndrome, abdominal pain, constipation or diarrhoea. Within 2 weeks these patients were sent postal questionnaires (n = 1770, 59% participation) to assess patient characteristics and treatment recommendations. Responders were sent follow-up questionnaires 6 months later (77% participation) to assess adherence and satisfaction with treatment.
  
  
  RESULTS
  Treatments employed most frequently were dietary advice, explanation, exercise advice, reassurance, advice to reduce stress and antispasmodic medications. Primary care physicians and gastroenterologists provided similar treatments. Patient confidence was higher for lifestyle advice (63-67, 100-point scale) than for medications (46-59). However, adherence was greater for medications (62-79 vs. 59-69, 100-point scale). Satisfactory relief was reported by 57%, but only 22% reported that symptom severity was reduced by half. Usual medical treatment was less effective for irritable bowel syndrome than for constipation, diarrhoea, or abdominal pain.
  
  
  CONCLUSIONS
  Usual medical care for irritable bowel syndrome emphasizes education and lifestyle modification more than drugs; patients have a greater expectation of benefit from lifestyle modification than drugs. Overall 57% of irritable bowel syndrome patients report satisfactory relief.
authors.affiliation: Center for Functional GI and Motility Disorders and Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, NC 27599-7555, USA. william_whitehead@med.unc.edu
authors.forename: W E
authors.initials: WE
authors.lastname: Whitehead
authors.forename: R L
authors.initials: RL
authors.lastname: Levy
authors.forename: M
authors.initials: M
authors.lastname: Von Korff
authors.forename: A D
authors.initials: AD
authors.lastname: Feld
authors.forename: O S
authors.initials: OS
authors.lastname: Palsson
authors.forename: M
authors.initials: M
authors.lastname: Turner
authors.forename: D A
authors.initials: DA
authors.lastname: Drossman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003376:Counseling; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000628:therapy*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D011788:Quality of Life; D012017:Referral and Consultation; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires
chemical_list: D005765:Gastrointestinal Agents