Commentary: Controversies in NICE guidance on irritable bowel syndrome

BMJ 2008; 336 doi: (Published 06 March 2008) Cite this as: BMJ 2008;336:558
  1. Nicholas J Talley, professor of medicine and epidemiology1
  1. 1Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32082, USA
  1. talley.nicholas{at}

    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 …

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