title: An exploration of the barriers to the confident diagnosis of irritable bowel syndrome: A survey among general practitioners, gastroenterologists and experts in five European countries.
abstract: BACKGROUND
  The diagnostic processes for chronic abdominal conditions are challenging. Despite their tendency for diagnostic tests in patients with irritable bowel syndrome (IBS) symptoms, clinicians are encouraged to make a positive diagnosis based on symptom criteria without alarm signs. We explored how European physicians diagnose and manage patients suffering from IBS.
  
  
  METHODS
  We conducted a vignette-based survey to evaluate the diagnostic approaches in four standardized patients with IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), inflammatory bowel disease (IBD) and chronic constipation (CC). General practitioners (GP, n = 104), gastroenterologists (GE, n = 100) and IBS experts (n = 25) from five European countries participated.
  
  
  RESULTS
  Experts showed the highest rates of correct diagnoses (88%-92%) for all cases except CC (only 60%) and were more prone to a positive diagnosis (64%/68% in IBS-C/CC), whereas GEs and GPs tended toward a diagnosis by exclusion (63%/63% and 62%/60% in IBS-C/CC). In the CC vignette, conducting tests was more frequent than prescribing treatment among 44% experts, 63% GEs and 36% GPs. The diagnosis of IBD presented little difficulty for any of the participants.
  
  
  CONCLUSIONS
  This study highlights the difficulties in confidently diagnosing chronic functional bowel conditions, especially for non-experts, whereas IBD caused little difficulty. Differentiating between IBS-C and CC seemed particularly challenging, even for experts.
authors: Israelitic Hospital, Hamburg, Germany.
authors: Viola
authors: V
authors: Andresen
authors: Wythenshawe Hospital, Manchester, UK.
authors: Peter
authors: P
authors: Whorwell
authors: Almirall, Barcelona, Spain.
authors: Josep
authors: J
authors: Fortea
authors: Kantar Health, Paris, France.
authors: Sébastien
authors: S
authors: Auzière
keywords: Chronic constipation; IBS-C; diagnostic approach; guidelines
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