Measuring the frequency of functional gastrointestinal disorders in rural Crete: a need for improving primary care physicians' diagnostic skills.
BACKGROUND
Studies of the frequency and aetiology of functional gastrointestinal disorders in the general population have received increasing interest over the past few years; the field seems to be neglected in Southern Europe. The aim of this study was to report on the frequency of functional dyspepsia (FD), irritable bowel syndrome (IBS) and gastroenteritis within the primary care setting, to provide some information on the extent to which the recorded diagnoses in the physicians' notes fulfil existing diagnostic criteria.


METHODS
A retrospective study was used, where all new cases of these diseases at five primary health care centres in three rural and two semi-rural areas of Crete were identified by scrutinizing medical records from 280,000 consecutive visits during a 4 year period. The occurrence rate per 1000 person-years were calculated for the three conditions. We also checked the extent to which the Talley's criteria for FD and Rome II diagnostic criteria for IBS were followed.


RESULTS
Gastroenteritis was revealed to be a quite frequent health problem among the rural population on Crete, while the occurrence rates for other problems, such as dyspepsia and IBS, were found to be lower than expected. IBS was over-represented among women compared with men, OR 2.04 (CI 1.39-3.00). In many cases a diagnosis of FD, IBS or gastroenteritis was evident to the research team on the basis of findings recorded in the notes, but the diagnosis was not recorded by the clinician at the time of consultation.


CONCLUSIONS
This study yielded two key messages: the first that gastroenteritis is still a frequent health problem, and the second that primary care physicians in rural Crete seem to fail in adequately diagnosing FD and IBS and need further training.
Lionis
Christos
C
Clinic of Social and Family Medicine, Heraklion, Crete, Greece. lionis@galinos.med.uoc.gr
Olsen-Faresjo
Ashild
A
Anastasiou
Foteini
F
Wallander
Mari-Ann
MA
Johansson
Saga
S
Faresjo
Tomas
T
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data; D004415:Dyspepsia / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data*; D017678:Sex Distribution