0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

The Irritable Bowel Syndrome: Long-Term Prognosis and the Physician-Patient Interaction

Dorothy M. Owens, MDiv, MA; Daniel K. Nelson, MS; and Nicholas J. Talley, MD, PhD
[+] Article and Author Information

From the Mayo Clinic and Foundation, Rochester, Minnesota. Requests for Reprints: Daniel K. Nelson, MS, Director of Research, Isaac Gordon Center, Genesee Hospital, University of Rochester, 224 Alexander Street, Rochester, NY 14607. Acknowledgments: The authors thank Alan R. Zinsmeister for assistance with the survival analysis; Kathleen L. Geisler and Joel B. Worra for computer consultation; Michael J. Ford for critical review; Vel R. Woyczik and Lois A. Law for manuscript preparation; and Richard M. Zaner, Volney P. Gay, Liston O. Mills, Christopher D. Lind, and James H. Hogge of Vanderbilt University for helpful suggestions. Grant Support: In part by RO1 grant AG09440 from the National Institutes of Health.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;122(2):107-112. doi:10.7326/0003-4819-122-2-199501150-00005
Text Size: A A A

Objective: To evaluate the long-term course and prognosis associated with the irritable bowel syndrome (IBS) and to determine the influence of an effective physician–patient relationship on subsequent health care use.

Design: Prospective review of medical records.

Setting: Tertiary referral center.

Patients: 112 consecutive Olmsted County, Minnesota, residents who were first diagnosed with IBS at the Mayo Clinic during the period 1961-1963.

Results: The median follow-up was 29 years (range, 1 to 32 years) and patients made a median of 2 return visits for IBS-related symptoms (range, 0 to 12 visits). In addition to abdominal pain, diarrhea (reported by 50% of patients) was the predominant bowel symptom at diagnosis. Organic gastrointestinal disease occurred in 10 patients a median of 15 years after diagnosis of IBS. Survival in patients with IBS did not differ from expected survival (27 deaths; median survival > 30 years after initial diagnosis). A positive physician–patient interaction, defined a priori using objective criteria in the written record, was associated with fewer return visits for IBS. Of the eight variables examined, notations in the medical record about psychosocial history, precipitating factors, and discussion of diagnosis and treatment with patients were associated with fewer return visits for IBS-related symptoms.

Conclusions: When diagnosed according to current criteria, IBS is associated with a good prognosis and the diagnosis is unlikely to be changed to that of an organic disease during follow-up. A positive physician–patient interaction may be related to reduced use of ambulatory health services by patients with IBS.

Figures

Grahic Jump Location
Figure 1.
Survival of the IBS cohort did not differ from expected survival.P

( = 0.59, one-sample log-rank test). Twenty-seven of 112 patients with IBS died during a 32-year follow-up.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Effects of physician–patient interaction on number of return visits.Top.PBottom.open barshatched bars

Number of return visits (mean ± SE) for IBS-related symptoms was inversely related ( < 0.01, analysis of variance) to the strength of the physician–patient interaction as reflected by the written medical record. Maximum possible score is 6; a higher score suggests a better interaction. Data viewed with respect to absence ( ) or presence ( ) of individual components making up the composite index of strength. A notation of any given variable contributed to the overall scoring of the physician–patient interaction.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)