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Recommendations for the management of irritable bowel syndrome in family practice

From the Departments of (Paterson, Vanner) Medicine and (Birtwhistle) Family Medicine, Queen's University, Kingston, Ont., the Departments of (Thompson) Medicine and (Faloon) Family Medicine, University of Ottawa, Ottawa, Ont., and (Rosser) the Department of Family Medicine, University of Toronto, Toronto, Ont. Dr. Morse is a family physician in Thornhill, Ont., and Dr. Touzel is a family physician in Napanee, Ont.
The IBS Consensus Conference Participants; The conference participants are listed at the end of the article.

Abstract

To help family physicians manage patients with irritable bowel syndrome (IBS), a consensus conference was convened in June 1997 at which 5 internationally recognized experts in IBS presented position papers on selected topics previously circulated to the conference participants.Five working groups comprising family physicians, gastroenterologists and allied health care professionals from across Canada were then charged with developing recommendations for the diagnosis, patient education, psychosocial management, dietary advice and pharmacotherapy, respectively. An evidence-based approach was used where possible; otherwise, recommendations were made by consensus. The participants concluded that family physicians can make a positive diagnosis of IBS using symptom criteria. The pathophysiology is poorly understood, but motility and sensory disturbances appear to play a role. Neither psychological nor specific dietary factors cause IBS, but both can trigger symptoms. Drug therapy is not recommended for the routine treatment of IBS, but short-term trials of drug therapy may be targeted to predominant symptoms in selected patients. A step-wise, patient-centred approach to management is outlined.

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