Recommendations for the management of irritable bowel syndrome in family practice

TO HELP FAMILY PHYSICIANS MANAGE PATIENTS with irritable bower syndrome (IB S), a consensus conference was convened in June 1997 at which 5 internation ally recognized experts in IBS presented position papers on selected topics previously circulated to the conference participants. Five working groups comprising family physicians, gastroenterologists and allied health care pr ofessionals from across Canada were then charged with developing recommenda tions for the diagnosis, patient education, psychosocial management, dietar y advice and pharmacotherapy, respectively. An evidence-based approach was used where possible; otherwise, recommendations were made by consensus. The participants concluded that family physicians can make a positive diagnosi s of IBS using symptom criteria. The pathophysiology is poorly understood, but motility and sensory disturbances appear to play a role. Neither psycho logical nor specific dietary factors cause IBS, but both can trigger sympto ms. Drug therapy is not recommended for the routine treatment of IBS, but s hort-term trials of drug therapy may be targeted to predominant symptoms in selected patients. A step-wise, patient-centred approach to management is outlined.