Neurogastroenterol Motil. 2024 Nov 20:e14967. doi: 10.1111/nmo.14967. Online ahead of print.

Joel J Heidelbaugh ¹, A Pali Hungin ², Olafur S Palsson ³, Foteini Anastasiou ⁴, Lars Agreus ⁵, Pierluigi Fracasso ⁶, Heidi-Ingrid Maaroos ⁷, Jalena Rakik Matic ⁸, Juan M Mendive ⁹, Bohumil Seifert ¹⁰, Douglas A Drossman ^11 12

Author information

¹Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.

²Primary Care and General Practice, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.

³Division of Gastroenterology and Hepatology, Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina, USA.

⁴4th Local Primary Care Team (TOMY), Municipality Practice, Academic Practice of Heraklion, Crete, Greece.

⁵Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.

⁶Italian Group for Primary Care Gastroenterology, Rome, Italy.

⁷Faculty of Medicine, University of Tartu, Tartu, Estonia.

⁸Health Center Zagreb West, Family Medicine Practice, Zagreb, Croatia.

⁹La Mina Primary Health Care Academic Centre, Catalan Health Institute (ICS), training Unit of Family Medicine, University of Barcelona, Barcelona, Spain.

¹⁰Institute of General Practice, First Faculty of Medicine, Charles University, Prague, Czech Republic.

¹¹Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, Center for Functional Gastrointestinal and Motility Disorders at the University of North Carolina, hapel Hill, North Carolina, USA.

¹²The Rome Foundation, Raleigh, North Carolina, USA.

Abstract

Background: The knowledge and proficiency of primary care practitioners (PCPs) in diagnosing and managing irritable bowel syndrome (IBS) remain generally low and variable internationally. This variability is partly due to a lack of familiarity with the Rome Foundation diagnostic criteria and treatment guidelines for this condition.

Methods: We conducted an electronic survey of PCPs in the United States and nine European countries to assess their understanding of IBS pathophysiology; the use of Rome IV criteria in diagnosis, knowledge of and frequency in prescribing various recommended treatments; and the likelihood of referring patients with suspected IBS to subspecialists.

Results: Most PCPs in the United States and Europe perceive IBS as a diagnosis of exclusion rather than a definitive diagnosis. They also believe IBS is underdiagnosed in primary care and challenging to diagnose confidently. The majority of PCPs consider diet as a crucial component of IBS management. Notably, US PCPs reported greater confidence than their European counterparts in recommending dietary interventions such as increased dietary fiber, a low FODMAP diet, and gluten restriction. Conversely, both groups exhibited moderate to high confidence in recommending over-the-counter treatments. European PCPs showed greater confidence in treating IBS with antispasmodics and secretagogues, while US PCPs expressed greater confidence in prescribing neuromodulators. Additionally, US PCPs were more likely to refer patients with suspected IBS to a gastroenterologist, whereas both US and European PCPs showed similar referral patterns to dietitians and referred very few patients to mental health providers. Both US and European PCPs reported that IBS is moderately to extremely difficult to treat effectively and emphasized the importance of a strong and longitudinal doctor-patient relationship in managing the condition.

Conclusion: Despite the Rome Foundation recommendations and criteria to support a positive diagnosis of IBS, most PCPs still rely on exclusionary investigations such as endoscopy and a serologic workup, while a significant percentage suggest referring patients to gastroenterologists.