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Determinants of Healthcare-Seeking Behaviour in IBS
      06/04/06 11:48 AM
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Determinants of Healthcare-Seeking Behaviour in IBS

From Alimentary Pharmacology & Therapeutics

R. E. Williams,* C. L. Black,† H.-Y. Kim,‡ E. B. Andrews,§ A. W. Mangel,§ J. J. Buda,§ & S. F. Cook,*

Aliment Pharmacol Ther. 2006;23(11):1667-1675. ©2006 Blackwell Publishing

Discussion
Our finding that 49% of IBS subjects in our sample had sought medical care for abdominal symptoms in the past year is higher than previous US population-based studies, which report consultation rates for IBS symptoms in the past 12 months of 14-25%.[1, 11, 19] However, our study likely represents a subset of IBS patients with more severe disease because the study design necessitated that all subjects fulfil a modified version of the Rome II criteria for a period of at least 2 years. We found that females were more likely than males to receive a diagnosis of IBS by a doctor despite the fact that males sought medical care for their abdominal symptoms more frequently than females. This finding has not been previously reported in the literature and is in contrast to a report by Borum,[20] who conducted a survey of internal medicine doctors and found that doctors perceive IBS as easier to diagnose in men than in women. Several researchers have reported that the Manning and Rome criteria are less sensitive in diagnosing IBS in men than in women,[21, 22] but our results show that doctors are less likely to diagnose IBS in men than in women even when the men have abdominal symptoms which fulfil criteria for IBS.

More than half (55%) of subjects that had sought health care in the past year reported that the purpose of their most recent doctor visit was to get treatment for symptoms because previous treatment was unsatisfactory. Patient dissatisfaction with IBS therapy is consistent with several recent literature reviews of IBS treatment, which found limited or no evidence for the efficacy of current IBS medications, with the possible exception of the newer serotenergic agents, which are currently only approved for use in a small subset of patients with IBS.[23-25]

While abdominal pain or discomfort was the most common reason for seeking care among the healthcare seekers in our study, the severity of abdominal pain was not significantly different between the healthcare seekers and those that did not seek health care for their IBS. Other studies have reported an association between the frequency and/or severity of abdominal pain and healthcare-seeking behaviour,[1, 5-11] but we likely did not find an association in our study because all subjects must have experienced some degree of abdominal pain in order to meet our criteria for IBS and must have experienced this symptom for at least 2 years in order to be included in the study.

While a few studies have reported symptoms other than abdominal pain such as bloating,[9, 10] mucus per rectum, urgency, incomplete evacuation[9] and diarrhoea[5, 9] to be associated with seeking health care for IBS, we evaluated numerous abdominal symptoms and found associations only with decreased bowel movements in females and abdominal cramping in males.

Although we found differences in males and females regarding specific factors motivating healthcare-seeking behaviour, our results in both sexes are consistent with the finding that the presence of medical conditions in addition to IBS is associated with seeking health care for IBS symptoms. Females suffering from dyspepsia and pelvic pain were more likely to seek health care for IBS than subjects without these comorbid conditions. In contrast to several other studies that did not report an association between age and healthcare-seeking behaviour,[1, 6, 9] we found that older females were more likely to seek medical care for IBS than younger females. This is probably because older subjects are more likely to suffer from comorbid conditions that we did not measure, such as hypertension or cancer, which put them in frequent contact with the medical system. Because we limited our original cohort to individuals between the ages of 18 and 65 years, we could not evaluate healthcare-seeking behaviour above our age limits. In men, having a working status of disabled is along a similar vain, as the disabling condition also likely causes the subject to have frequent medical visits.

Earlier studies of healthcare-seeking behaviour and IBS concluded that symptoms of psychological distress are unrelated to IBS, but influence which patients will seek medical care for the condition.[4, 5] Our results are contrary to this finding. In a previous analysis, we found that subjects that continued to have IBS over a 2-year period had more psychological impairment that subjects that did not continue to have IBS during the follow-up period.[26] However, among those subjects that continued to meet the IBS criteria there was no difference in mental health status between healthcare seekers and healthcare non-seekers. Other recent studies have also found no association between psychological morbidity and seeking health care for IBS.[6, 27]

While we did not find an association with mental illness, we did find that the extent to which the subjects' IBS affected their physical and social functioning, as reflected in the IBSQOL scores, was important in distinguishing between those subjects that sought medical care for their IBS symptoms and those that did not. Greater interference of gastrointestinal symptoms with work and activities[6] and reduced IBS-specific quality of life[12] have previously been identified as predictors of health care use among IBS subjects. In our study, quality of life issues had a greater impact on the healthcare-seeking behaviour of males than that of females.

Among females in our study, healthcare seeking was related to worry that their abdominal symptoms were related to cancer or other serious illness. Gick and Thompson[28] found that healthcare seeking among IBS subjects was associated with concern about the meaning of IBS symptoms but not anxiety trait in general. This is consistent with our finding that healthcare seekers were more likely than non-seekers to have anxiety regarding their IBS symptoms but not psychological dysfunction otherwise. Other studies have reported concern about the serious nature of their symptoms[10] and anxiety about abdominal pain[29] to be more prevalent in healthcare seekers than non-seekers, but these studies also report greater levels of psychological distress among healthcare seekers. The latter study included patients with all functional gastrointestinal disorders, not solely IBS.

In conclusion, we found that healthcare-seeking behaviour among IBS subjects were determined by the presence of comorbid medical conditions and the extent to which their IBS symptoms affected their physical and mental well-being rather than by the nature of their physical symptoms or any underlying psychological morbidity.




http://www.medscape.com/viewarticle/532484_1

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* Diagnostic Yield of Alarm Features in Irritable Bowel Syndrome
HeatherAdministrator
06/20/05 03:44 PM
* Colon Cancer Test Misses Growths in Women
HeatherAdministrator
06/05/05 05:56 PM
* Nongastrointestinal symptoms of irritable bowel syndrome
HeatherAdministrator
05/22/05 07:14 PM
* Partnering With Gastroenterologists to Evaluate Patients With Chronic Constipation
HeatherAdministrator
05/08/05 06:16 PM
* Impairment in Work Productivity and Health-related Quality of Life in Patients With IBS
HeatherAdministrator
05/08/05 06:11 PM
* Nerves, Reflexes, and the Enteric Nervous System: Pathogenesis of the Irritable Bowel Syndrome
HeatherAdministrator
05/08/05 06:06 PM
* What Does the Future Hold for Irritable Bowel Syndrome
HeatherAdministrator
05/08/05 06:02 PM
* Towards a better understanding of abdominal bloating and distension in functional GI disorders
HeatherAdministrator
04/24/05 03:40 PM
* IBS is a risk factor for GERD
HeatherAdministrator
04/10/05 06:25 PM
* New Recommendations for Treating Children With Chronic Abdominal Pain
HeatherAdministrator
03/28/05 01:59 PM
* Irritable bowel syndrome in developing countries
HeatherAdministrator
03/28/05 01:29 PM
* Stress and the gastrointestinal tract
HeatherAdministrator
03/28/05 01:27 PM
* Alternating Bowel Habit Subtype in Patients with Irritable Bowel Syndrome
HeatherAdministrator
03/28/05 12:28 PM
* Fecal Microbiota of Irritable Bowel Syndrome Patients
HeatherAdministrator
03/04/05 12:11 PM
* Post-infectious IBS in patients with Shigella infection
HeatherAdministrator
03/04/05 12:03 PM
* Surgical Treatment of Chronic Functional Constipation?
HeatherAdministrator
03/04/05 11:24 AM
* Chronic constipation in children
HeatherAdministrator
02/19/05 05:53 PM
* Intestinal infection and irritable bowel syndrome.
HeatherAdministrator
02/19/05 05:36 PM
* Overlap of GI symptom complexes in a US community
HeatherAdministrator
02/06/05 02:35 PM
* Magnetic pill tracking: a novel non-invasive tool for investigation of human digestive motility
HeatherAdministrator
02/06/05 02:27 PM
* The value of a general therapeutic approach in subjects with irritable bowel syndrome
HeatherAdministrator
02/06/05 02:22 PM
* Is Constipation Associated with Decreased Physical Activity in Normally Active Subjects?
HeatherAdministrator
02/06/05 02:18 PM
* High interdigestive and postprandial motilin levels in patients with the irritable bowel syndrome
HeatherAdministrator
02/06/05 02:12 PM
* 10% to 20% of older adults have IBS
HeatherAdministrator
01/23/05 05:05 PM
* Diagnostic Criteria for Irritable Bowel Syndrome - Family Practice Doctors Unaware of Guidelines
HeatherAdministrator
01/07/05 06:20 PM
* Stress Increases Visceral Sensitivity in IBS Patients
HeatherAdministrator
01/07/05 06:13 PM
* Treatment of irritable bowel syndrome with colonic pacing
HeatherAdministrator
01/07/05 05:53 PM
* Irritable bowel syndrome: colonoscopy painful and difficult?
HeatherAdministrator
01/07/05 05:50 PM
* Suicide in IBS patients emphasizes need for improvements in treatment
HeatherAdministrator
01/07/05 05:47 PM
* New Risk for Asthma, Allergy Found in the Gut
HeatherAdministrator
01/07/05 04:53 PM
* Salt intake and smoking play major roles in GERD
HeatherAdministrator
12/20/04 02:11 PM
* Constipation and Laxative Use Found to Increase Colon Cancer Risk
HeatherAdministrator
12/20/04 01:30 PM
* Link Between Irritable Bowel Syndrome (IBS), Alcoholism and Mental Illness
HeatherAdministrator
12/20/04 01:24 PM
* Complementary and alternative medicine in gastroenterology
HeatherAdministrator
12/20/04 01:16 PM
* Advances in the Treatment of Chronic Constipation
HeatherAdministrator
11/28/04 02:55 PM
* Symptom patterns in functional dyspepsia and irritable bowel syndrome
HeatherAdministrator
11/28/04 02:34 PM
* Obese Women Face Higher Risk of Colorectal Cancer
HeatherAdministrator
11/08/04 04:48 PM
* Obesity is Associated With Increased Risk of Gastrointestinal Symptoms
HeatherAdministrator
10/24/04 07:42 PM
* Stress Therapy Can Help Irritable Bowel
HeatherAdministrator
10/24/04 07:38 PM
* Relationship Between Colon Ischemia, Irritable Bowel Syndrome
HeatherAdministrator
10/11/04 04:15 PM
* Clinical Update on the Treatment of Constipation in Adults
HeatherAdministrator
10/11/04 03:34 PM
* Racial Differences in the Impact of Irritable Bowel Syndrome on Health-Related Quality of Life
HeatherAdministrator
10/11/04 03:25 PM
* What Differentiates Chronic Constipation From IBS With Constipation?
HeatherAdministrator
09/26/04 03:25 PM
* Treatment options in irritable bowel syndrome
HeatherAdministrator
09/26/04 02:57 PM
* Diagnostic approach to suspected irritable bowel syndrome
HeatherAdministrator
09/12/04 03:38 PM
* Dyssynergic Defecation: Demographics, Symptoms, Stool Patterns, and Quality of Life
HeatherAdministrator
09/12/04 03:35 PM
* Small Intestinal Bacterial Overgrowth - A Framework for Understanding IBS
HeatherAdministrator
08/30/04 01:46 PM
* New views - and some respect - for IBS
HeatherAdministrator
08/30/04 01:25 PM
* Categorization of dysmotility in patients with chronic constipation
HeatherAdministrator
08/08/04 02:54 PM
* Prevalence of IBS according to different diagnostic criteria
HeatherAdministrator
08/08/04 02:50 PM
* Irritable Bowel Can Follow Dysentery
HeatherAdministrator
08/08/04 02:37 PM
* Irritable Bowel Syndrome Remains a Difficult Condition to Manage
HeatherAdministrator
07/24/04 02:09 PM
* Intolerance to visceral distension in functional dyspepsia or irritable bowel syndrome
HeatherAdministrator
07/24/04 02:17 PM
* Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis
HeatherAdministrator
07/24/04 01:42 PM
* Irritable Bowel Syndrome Linked to High Rates of Various Surgeries
HeatherAdministrator
07/11/04 02:15 PM
* Drug-Free Ways to Treat IBS
HeatherAdministrator
07/11/04 01:47 PM
* Irritable Bowel Syndrome - An Evidence-Based Approach to Diagnosis
HeatherAdministrator
06/27/04 01:14 PM
* Biases Affect Treatment of IBS
HeatherAdministrator
06/04/04 06:45 PM
* Moms with Bowel Symptoms Take Baby to Doctor More
HeatherAdministrator
05/25/04 11:53 AM
* Natural History of Irritable Bowel Syndrome
HeatherAdministrator
05/10/04 02:36 PM
* Intestinal Gas May Contribute to IBS Symptoms
HeatherAdministrator
05/10/04 02:29 PM
* Are Your Bowels Irritable? IBS Awareness Month is Here
HeatherAdministrator
04/09/04 07:11 PM
* Heartburn May Not Reflect Gastroesophageal Reflux Disease Severity
HeatherAdministrator
03/30/04 02:43 PM
* A link between irritable bowel syndrome and fibromyalgia
HeatherAdministrator
03/30/04 01:46 PM
* Diverticular Disease: Electrophysiologic Study and a New Concept of Pathogenesis
HeatherAdministrator
03/09/04 11:48 AM
* New Syndrome Connects Gallbladder Dysfunction And Chronic Diarrhea
HeatherAdministrator
03/09/04 11:45 AM
* Researchers Pioneer Accessible, Cost-Effective Treatments for IBS
HeatherAdministrator
03/08/04 06:48 PM
* Splitting IBS: from original Rome to Rome II criteria
HeatherAdministrator
02/10/04 02:35 PM
* Utilization patterns and net direct medical cost to Medicaid of IBS
HeatherAdministrator
02/10/04 02:34 PM
* Family practitioners' attitudes and knowledge about IBS
HeatherAdministrator
02/10/04 02:32 PM
* The Effect of Somatization on Gastrointestinal and Extraintestinal Symptoms of IBS
HeatherAdministrator
01/26/04 03:26 PM
* Surgery and IBS
HeatherAdministrator
01/26/04 03:21 PM
* IBS Subgroups by Bowel Habit Predominance
HeatherAdministrator
01/26/04 03:13 PM
* Visceral perception thresholds in irritable bowel syndrome
HeatherAdministrator
01/07/04 11:56 AM
* Electric activity of the colon in irritable bowel syndrome
HeatherAdministrator
01/07/04 11:52 AM
* Irritable Bowel Syndrome's Possible Genetic Link
HeatherAdministrator
01/07/04 11:40 AM
* Intestinal gas distribution determines abdominal symptoms
HeatherAdministrator
12/16/03 12:27 PM
* Faecal incontinence - Many treatment options now exist
HeatherAdministrator
12/16/03 12:17 PM
* Abnormal Colonic Propagated Activity in Patients with Constipation
HeatherAdministrator
12/16/03 12:07 PM
* Colonic Propulsive Impairment in Intractable Slow-Transit Constipation
HeatherAdministrator
12/16/03 12:03 PM
* Overlapping upper and lower GI symptoms in IBS patients with constipation or diarrhea
HeatherAdministrator
12/01/03 05:51 PM
* Familial aggregation of irritable bowel syndrome
HeatherAdministrator
12/01/03 05:49 PM
* Outlook affects bowel disorder patients
HeatherAdministrator
11/18/03 03:30 PM
* Doctors unmoved by bowel misery
HeatherAdministrator
11/18/03 03:28 PM
* Travelers' Diarrhoea Can Trigger Irritable Bowel
HeatherAdministrator
11/04/03 03:21 PM
* Mind-Body Technique Eases Kids' Gut Pain
HeatherAdministrator
10/30/03 11:17 AM
* Molecular Alterations In Patients With Irritable Bowel Syndrome
HeatherAdministrator
10/20/03 03:46 PM
* Three in Four People With IBS Also Have Functional Dyspepsia
HeatherAdministrator
10/15/03 03:28 PM
* Infectious Gastroenteritis Linked to Irritable Bowel Syndrome
HeatherAdministrator
09/30/03 02:27 PM
* Association Between Pain Episodes & High Amplitude Pressure Waves in IBS
HeatherAdministrator
09/16/03 03:54 PM
* Constipation and its management
HeatherAdministrator
09/16/03 03:41 PM
* Contributions of suggestion, desire, and expectation to placebo effects in IBS patients
HeatherAdministrator
09/16/03 03:28 PM
* Do published guidelines for evaluation of IBS reflect practice?
HeatherAdministrator
08/30/03 02:40 PM
* Cognitive-behavioral therapy versus education and desipramine versus placebo for IBS
HeatherAdministrator
08/12/03 12:54 PM
* Distinctive features of postinfective irritable bowel syndrome
HeatherAdministrator
07/28/03 03:18 PM
* UCLA/CURE Neuroenteric Disease Program Newsletter
HeatherAdministrator
07/23/03 10:38 AM
* Bacterial Overgrowth in IBS
HeatherAdministrator
07/18/03 12:15 PM
* Diagnosis of irritable bowel syndrome.
HeatherAdministrator
07/18/03 11:54 AM
* Eradication of small intestinal bacterial overgrowth reduces symptoms of IBS
HeatherAdministrator
07/18/03 11:44 AM
* Antibiotics increase functional abdominal symptoms.
HeatherAdministrator
07/18/03 11:41 AM
* Treatment of the irritable bowel syndrome.
HeatherAdministrator
07/15/03 11:02 PM
* Extraintestinal symptoms in IBS and IBD
HeatherAdministrator
07/15/03 06:21 PM
* Postinfectious irritable bowel syndrome.
HeatherAdministrator
07/15/03 06:19 PM
* Dieting severity and GI symptoms in college women.
HeatherAdministrator
07/15/03 01:13 PM
* Functional GI disorders and eating disorders - Relevance of the association
HeatherAdministrator
07/15/03 11:14 AM
* Features of eating disorders in patients with IBS
HeatherAdministrator
07/15/03 11:12 AM
* New and Important Insights Into IBS
HeatherAdministrator
07/14/03 03:24 PM
* The Irritable Bowel Syndrome-Fibromyalgia Connection
HeatherAdministrator
07/14/03 03:19 PM
* Update on Treatment of Functional Gastrointestinal Disorders
HeatherAdministrator
07/14/03 02:55 PM
* Irritable bowel syndrome in primary care: The patients’ and doctors’ views
HeatherAdministrator
07/14/03 02:43 PM
* Inflammatory bowel disease and irritable bowel syndrome: separate or unified?
HeatherAdministrator
07/14/03 02:32 PM

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