BMJ  2008;336:558-559 (8 March), doi:10.1136/bmj.39504.409329.AD

Practice

Commentary: Controversies in NICE guidance on irritable bowel syndrome

¹ Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32082, USA

doi: 10.1136/bmj.39484.712616.AD

The first 150 words of the full text of this article appear below.

The NICE guidelines summarise the diagnosis and treatment of irritable bowel syndrome (IBS), but several issues remain contentious.

Can a positive diagnosis of IBS be based on symptom patterns?

The NICE guidelines offer a pragmatic definition of IBS, similar to one published in 2002 by the American College of Gastroenterology Taskforce.¹ However, the utility of these pragmatic definitions is unknown. The Rome criteria for IBS were developed for research purposes and are specific, but there are no adequate validation data documenting their applicability in primary care.^{1 2} The NICE guidelines suggest that symptoms that are made worse by eating support a diagnosis of IBS, but as acknowledged in the guidelines, this is based on expert consensus rather than research evidence. Clinicians need to be aware that this symptom may lead to confusion with functional dyspepsia and peptic ulcer disease. Making a positive diagnosis of IBS seems reasonable, but the approach applied still is largely based on expert opinion, not high quality evidence.

Are "red flag" indicators truly useful for predicting organic disease?

. . . [Full text of this article]

Should blood testing be routine in those with typical features of IBS?

Is fibre harmful?

Psychopharmacotherapy in IBS: better targeting of drug class and dose?

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