title: Use of Rome criteria for the diagnosis of irritable bowel syndrome in primary care: a survey among European countries.
abstract: OBJECTIVE
  The majority of patients with irritable bowel syndrome (IBS) are diagnosed and treated in primary care. The aim of this study was to investigate the implementation of the Rome criteria in daily primary care clinical practice and adherence of general practitioners (GPs) to recommended diagnostic approaches for IBS.
  
  
  METHODS
  A survey consisting of 18 questions was distributed across 11 European countries and was used to assess GPs' diagnostic approach of IBS, the use of Rome criteria in daily practice and GPs' perspective on the aetiology of the disorder.
  
  
  RESULTS
  Overall, 185 GPs completed the survey. In daily clinical practice, 32% of GPs reported that they usually make a positive diagnosis on the basis of symptoms only, whereas 36% of GPs reported regular use of the Rome criteria to diagnose IBS. Furthermore, 62% of the responders reported that they applied additional diagnostics, such as blood tests, 31% found it necessary to perform endoscopy to make a positive diagnosis of IBS and 29% referred patients with IBS to a specialist. Psychological factors were the most frequently selected potential aetiological factor of IBS (88% of GPs). Overall, 52% of GPs reported systematically including questions on psychological symptoms in the assessment of history of IBS.
  
  
  CONCLUSIONS
  Only about one-third of GPs regularly used the Rome criteria to diagnose IBS. In daily primary care practice, IBS largely remains a diagnosis of exclusion. This has implications in terms of GPs' specialty training and questions the applicability of IBS guidelines in daily care, which advocate an early, positive, symptom-based diagnosis.
authors.affiliation: aDepartment of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center bDepartment of Psychiatry and Psychology, Maastricht University Medical Center cDepartment of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht dJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands eSchool of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK fResearch Unit for General Practice, Uni Research Health, Bergen, Norway gDepartment of Family Medicine, Internal and Geriatric Medicine, Jagiellonian University Medical College, Cracow, Poland.
authors.forename: Zlatan
authors.initials: Z
authors.lastname: Mujagic
authors.forename: Daisy M A E
authors.initials: DMAE
authors.lastname: Jonkers
authors.forename: A Pali S
authors.initials: APS
authors.lastname: Hungin
authors.forename: Niek J
authors.initials: NJ
authors.lastname: de Wit
authors.forename: Knut-Arne
authors.initials: KA
authors.lastname: Wensaas
authors.forename: Margaret
authors.initials: M
authors.lastname: Palka
authors.forename: Vico
authors.initials: V
authors.lastname: Leeters
authors.forename: Joanna W
authors.initials: JW
authors.lastname: Kruimel
authors.forename: Carsten
authors.initials: C
authors.lastname: Leue
authors.forename: Ad A M
authors.initials: AAM
authors.lastname: Masclee
authors.forename: Jean W M
authors.initials: JWM
authors.lastname: Muris
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D003672:Defecation; D003937:Diagnosis, Differential; D003938:Diagnostic Techniques, Digestive System / Q000592:standards; D016099:Endoscopy, Gastrointestinal; D005060:Europe; D005243:Feces / Q000737:chemistry; D058005:General Practitioners / Q000592:standards; D019983:Guideline Adherence; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000592:standards; D011379:Prognosis; D012008:Recurrence; D012017:Referral and Consultation; D012307:Risk Factors