Genevieve Parecki, BS1, Amy Wozniak1, Ayokunle T. Abegunde, MD, MSc, MRCGP2; 1Loyola University of Chicago, Maywood, IL; 2Loyola University Medical Center, Maywood, IL
Introduction: Irritable bowel syndrome (IBS) is a relatively prevalent functional disorder of the gut. While this condition may be managed on an outpatient basis, primary care providers (PCPs) may not feel confident diagnosing and managing IBS without input from gastroenterologists (GEs). The aim of this study was to examine disparities between PCP and GE diagnosis and management of IBS. Methods: We identified adult patients with a diagnosis of IBS by ICD-10 codes and randomly selected 1000 patients for chart review. We extracted data on demography, comorbidities, diagnostic tests, endoscopy, pathology reports, and outcomes. Outpatient notes were reviewed and we used the Rome IV IBS criteria to determine the appropriate diagnosis. We compared the results with the primary diagnosis of PCPs or GEs and analyzed the data for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The study population consisted of 1000 patients, aged 18-65 years. The median age was 45 years with a standard deviation of 12 years, 76.9% were female (Table1). Sensitivity of an IBS diagnosis by PCP was 77.6% (95% CI 73.3-81.9) compared with 60.1% (95% CI 54.7-65.6) for GE. Specificity of an IBS diagnosis by PCP was 27.5% (95% CI 23.5-31.5) compared with 71.1% (95% CI 64.6-77.5) for GE diagnosis of IBS. A GE diagnosis of IBS carried a high PPV (77.3%) compared with (44.6%) for PCP (Table 2). There was no significant difference between PCP and GE regarding the median number of diagnostic tests required to diagnose IBS (3 vs. 2, P= 0.721). Of 174 patients with outcome data, 69.5% had resolution of symptoms at follow up. Discussion: The sensitivity of GE diagnosis of IBS, while lower than that of PCP, closely matches the reported sensitivity of the Rome IV criteria for IBS in validation studies. The specificity and PPV suggest more thorough documentation of symptoms and more cautious diagnosis by GEs, with PCPs more likely to assign a diagnosis of IBS incorrectly or without sufficient documentation of symptoms fulfilling Rome IV criteria. This study affirms that while PCPs may benefit from more information about IBS, they need not rely on GE diagnosis and management. Studies of interventions to increase the specificity and PPV of PCP diagnosis of IBS are required.
Table 1. Patient characteristics
Table 2. Sensitivity and specificity of GE and PCP diagnosis of IBS
Disclosures: Genevieve Parecki indicated no relevant financial relationships. Amy Wozniak indicated no relevant financial relationships. Ayokunle Abegunde indicated no relevant financial relationships.