515
Views
6
CrossRef citations to date
0
Altmetric
RESEARCH LETTER

Patients with irritable bowel syndrome in Swedish primary care

, , , &
Pages 88-90 | Received 26 Feb 2006, Published online: 11 Jul 2009

Introduction

Irritable bowel syndrome (IBS) is a chronic recurring gastrointestinal disorder quite commonly diagnosed in primary care Citation[1–3]. However, there are deficient data on the rates of health care utilization in primary care by patients with IBS Citation[4], Citation[5]. An earlier Swedish study reported an IBS incidence rate of 2 per 1 000 person-years Citation[1]. In studies from the UK and USA, incidence rates of 2–3 cases per 1 000 person-years have been reported Citation[2], Citation[6]. Other factors than gastrointestinal (GI) symptoms might also be important when it comes to seeking health care Citation[7], Citation[8]. IBS patients have been documented with a higher prevalence of stress and mental diagnoses, compared to the general population Citation[3], Citation[9], Citation[10].

Research on IBS has so far mostly been based on hospital outpatients rather than primary care patients Citation[11]. More research concerning consulting pattern, incidence, diagnosis, medication and treatment of patients with IBS in general practice is warranted Citation[11]. Accordingly, in this study we have focused on computerized medical records of IBS patients in primary care.

Aim

The aim of this study was to estimate the consulting incidence of IBS and the consulting pattern for this patient population in a well defined primary care region.

Methods

All diagnosed cases with IBS (n=849) at three primary health care centres (PHC) in Linköping, Sweden, covering a total study population of over 40 000 inhabitants, were identified retrospectively through computerized medical records for a 5-year period. IBS cases were identified according to (International Classification of Diseases) ICD-10-P (code K-58-p), in the medical records. The cases were also checked 3 years prior to their IBS diagnosis to exclude IBS cases with a confirmed diagnosis before the period studied. Applying this criteria n=115 prevalent cases were excluded together with a further n=11 IBS cases with non-accessible medical record, thus giving a study group of n=723 IBS cases. Data comprise information (such as number of health care visits, reason for consulting and perceived complaints such as stress in daily life) from all GP consultations were the diagnosis IBS was registered in the medical records.

All data were stored in a common database and statistically analysed using the (Statistical Package for the Social Sciences) SPSS program (version 11.0). In the statistical analysis, differences were assessed by the chi-square method. IBS occurrence rates were calculated as incidence rates per 1 000 person-years. Logistic regression analysis was used to estimate the relative risks with 95% confidence intervals (CI) of different complaints as dependent variables associated with age and gender as the independent variables. This study was approved in 2002 by the Research Ethics Committee of the Faculty of Health Sciences, Linköping University, Sweden.

Results

The consultation incidence of IBS was 3.4 (95% CI 3.20–3.70) per 1 000 person-years; females: 4.6 (95% CI 4.16–4.97) and males: 2.3 (95% CI 2.01–2.59), see . The incidence in females was more than double that of men in all age-groups except in the youngest age-group. The relative risk among females compared to males was 1.99 (95% CI 1.70–2.31).

Figure 1.  Consulting incidence rates per 1 000 person-years for female and male irritable bowel syndrome (IBS) cases in different age-groups.

Figure 1.  Consulting incidence rates per 1 000 person-years for female and male irritable bowel syndrome (IBS) cases in different age-groups.

Of all the IBS cases, 63% had abdominal discomfort documented as the main reason for consulting their GP and 31% had abdominal discomfort in combination with non-abdominal complaints and 6% had other discomforts recorded as the main reason for the consultation. No gender difference in these respects was found. 52% consulted their GP at an open surgery without an appointment. Planned consultations were more common (p<0.0001) among the elderly while consultations without an appointment were more common among the younger patients (p<0.0001). Some seasonal variation among the initial GP consultations was found, with peaks in the spring and autumn, although not statistically significant. For 24% of the IBS cases there were documented complaints of stress in daily life, especially among the gainfully employed (p<0.0001).

Discussion

Studies of incidence rates for IBS are quite rare, whereas prevalence studies in the general population based on surveys are available in several countries Citation[1], Citation[2], Citation[5], Citation[12–14]. The incidence rate found in this study, 3.4 per 1 000 person-years which increased with age, was slightly higher than what has been found in other comparable studies Citation[1], Citation[2], Citation[6]. This increases with age and the overrepresentation of females found is in line with prevalence studies Citation[7], Citation[15], Citation[16].

It has been noted that the reason for IBS patients to consult their GP is often related to fear of a serious illness Citation[17]. In this study, the majority of the patients consulted without an appointment and had abdominal discomfort as sole consulting reason. Stress in everyday life was frequently recorded among the IBS patients, which is in accordance with other studies Citation[3], Citation[9], Citation[10].

Medical records in primary care in Sweden are generally regarded as a good source of data on health care utilization. Computerized medical records have attracted more interest as an invaluable source of data for shedding light on diseases in primary care Citation[18], Citation[19] and studies with this approach have been performed Citation[20], Citation[21].

This study was supported by a grant from AstraZeneca R&D, Mölndal, Sweden. We also want to express our gratitude to the staff at the participating primary health care centres in Linköping.

References

  • Agreùs L, Svärdsudd K, Nyren O, Tibblin G. Irritable Bowel Syndrome and Dyspepsia in the general population: overlap and lack of stability over time. Gastroenterology 1995; 109: 761–80
  • Ruigòmez A, Wallander MA, Johansson S, Garcia Rodriguez LA. One-year follow-up of newly diagnosed irritable bowel syndrome patients. Aliment Pharmacol Ther 1999; 13: 1097–102
  • Hislop IG. Psychological significance of the irritable colon syndrome. Gut 1917; 12: 452–7
  • Gralnek IM. Health care utilization and economic issues in irritable bowel syndrome. Eur J Surg Suppl. 1998;(583):73–6.
  • Thompson WG, Heaton KW, Smyth GT, Smyth C. Irritable bowel syndrome in general Practice: prevalence, characteristics and referral. Gut 2000; 46: 78–82
  • Locke III GR, Yamn BP, Wollan PC, Melton LJ 3rd, Lydick E, Talley NJ. Incidence of a clinical diagnosis of the irritable bowel syndrome in a United States population. Aliment Pharmacol Ther 2004; 19: 1025–31
  • Talley NJ, Boyce PM, Jones M. Predictors of health care seeking for irritable bowel syndrome: a population based study. Gut 1997; 41: 394–8
  • Koloski NA, Talley NJ, Huskic SS, Boyce PM. Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia. Aliment Pharmacol Ther 2003; 17: 841–51
  • Addorato G, Marsigli L, Capristo E, Caputo F, Dall'Aglio C, Baudanza P. Anxiety and depression: A common feature of health care seeking patients with irritable bowel syndrome and food allergy. Hepato-Gastroenterology 1998; 45: 1559–64
  • Ford MJ, MacMillar P, Eastwood J, Eastwood MA. Life events, psychiatric illness and irritable bowel syndrome. Gut 1987; 28: 160–5
  • Thompsson WG, Heaton KW, Smyth GT, Smyth C. Irritable bowel syndrome: the view from general practice. Eur J Gastroenterol Hepatol 1997; 9: 689–92
  • Bommelaer G, Dorval E, Denis P, Czernichow P, Frexinos J, Pelc A, et al. Prevalence of irritable bowel syndrome in the French population according to the Rome I criteria. Gastroenterol Clin Biol 2002; 26: 1118–23
  • Icks A, Haastert B, Enck P, Rathmann W, Giani G. Prevalence of functional bowel disorder and related health care seeking: a population-based study. Z Gastroenterol 2002; 40: 177–83
  • Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ 1992; 304: 87–90
  • Levy RL, Cain KC, Jarett M, Heitkemper MM. The relationship between daily life stress and gastrointestinal symptoms in women with irritable bowel syndrome. J Behav Med 1997; 20: 177–93
  • Ehrenpreis ED. Irritable bowel syndrome. 10% to 20% of older adults have symptoms consistent with diagnosis. Geriatrics 2005; 60: 25–8
  • Kettel J, Jones R, Lydeard S. Reasons for consultation in irritable bowel syndrome: symptoms and patient characteristics. Br J Gen Pract 1992; 42: 459–61
  • Flemm D. Using electronic medical records for research. Editorial. Eur J Gen Pract 2005; 11: 2
  • Kurland LT, Molgaard CA. The patient record in epidemiology. Sci Am 1981; 245: 46–55
  • Jick SS, Kaye JA, Vasilakis-Scramozza C, Garcia Rodriguez LA, Ruigomez A, Meier CR. Validity of general practice research database. Pharmacotherapy 2003; 23: 686–9
  • Roel E, Olsen-Faresjö Å, Kjellman M N-I, Faresjö T. Cumulative incidence of asthma diagnosis at the age of seven in a birth cohort. Eur J Gen Pract 1999; 5: 71–4

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.