title: Evaluation of possible inflammatory bowel disease: a survey of Rhode Island physicians.
abstract: BACKGROUND
  Patients with undiagnosed inflammatory bowel disease (IBD) are often evaluated initially by primary care physicians (PCPs). Despite the frequency with which PCPs evaluate chronic abdominal pain and chronic diarrhea, little is known about how they approach these symptoms.
  
  
  OBJECTIVE
  To determine the diagnostic practices and referral patterns of PCPs when confronting a patient with potential IBD.
  
  
  METHODS
  We conducted a mail survey of PCPs practicing in Rhode Island. Clinical vignettes describing patients with chronic abdominal pain and chronic diarrhea were presented. Respondents were asked to indicate how they would evaluate these scenarios and when they would refer to a specialist.
  
  
  RESULTS
  432 PCPs were surveyed; 35.6% responded. Wide variation in PCPs' definitions of chronic abdominal pain and chronic diarrhea was found, with only 26% and 51% of physicians, respectively, defining these symptoms to be chronic per standard definitions. Laboratory testing was found to vary significantly with practice type (p < 0.01 for 2 patient groups). Patient age influenced the ordering of diagnostic imaging (p < 0.0001), while patient gender did not.
  
  
  CONCLUSIONS
  There is significant variability among PCPs in the threshold after which common gastrointestinal symptoms become chronic as well as in their diagnostic evaluation of these symptoms. This variability may lead to a lag in the diagnosis of IBD and influence patient outcomes.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, USA.
authors.forename: Sumona
authors.initials: S
authors.lastname: Saha
authors.forename: Manuel
authors.initials: M
authors.lastname: Lam
authors.forename: Erica
authors.initials: E
authors.lastname: Roberson
authors.forename: Samir
authors.initials: S
authors.lastname: Shah
authors.forename: Neal S
authors.initials: NS
authors.lastname: LeLeiko
authors.forename: Sheldon
authors.initials: S
authors.lastname: Lidofsky
authors.forename: Renee
authors.initials: R
authors.lastname: Bright
authors.forename: Nicole
authors.initials: N
authors.lastname: Flowers
authors.forename: Marjorie
authors.initials: M
authors.lastname: Merrick
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Sands
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012237:Rhode Island