THE IRRITABLE-BOWEL-SYNDROME - LONG-TERM PROGNOSIS AND THE PHYSICIAN-PATIENT INTERACTION

Objective: To evaluate the long-term course and prognosis associated w ith the irritable bowel syndrome (IBS) and to determine the influence of an effective physician-patient relationship on subsequent health ca re use. Design: Prospective review of medical records. Setting: Tertia ry referral center. Patients: 112 consecutive Olmsted County, Minnesot a, residents who were first diagnosed with IBS at the Mayo Clinic duri ng the period 1961-1963. Results: The median follow-up was 29 years (r ange, 1 to 32 years) and patients made a median of 2 return visits for IBS-related symptoms (range, 0 to 12 visits). In addition to abdomina l pain, diarrhea (reported by 50% of patients) was the predominant bow el symptom at diagnosis. Organic gastrointestinal disease occurred in 10 patients a median of 15 years after diagnosis of IBS. Survival in p atients with IBS did not differ from expected survival (27 deaths; med ian survival > 30 years after initial diagnosis). A positive physician -patient interaction, defined a priori using objective criteria in the written record, was associated with fewer return visits for IBS. Of t he eight variables examined, notations in the medical record about psy chosocial history, precipitating factors, and discussion of diagnosis and treatment with patients were associated with fewer return visits f or IBS-related symptoms. Conclusions: When diagnosed according to curr ent criteria, IBS is associated with a good prognosis and the diagnosi s is unlikely to be changed to that of an organic disease during follo w-up. A positive physician-patient interaction may be related to reduc ed use of ambulatory health services by patients with IBS.