Trends in Ambulatory Care for IBS, 1993-2010

Orlando—Noting that irritable bowel syndrome (IBS) is a common condition that is costly to treat, researchers recently conducted a study to identify trends in IBS-related physician visits, evaluation, and management in the United States over the past 2 decades.

The study evaluated data on outpatient visits related to IBS between 1993 and 2010 using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Results were presented at a poster session during DDW 2013 in Orlando, Florida. The poster was titled Ambulatory Care for Irritable Bowel Syndrome in the United States, 1993-2010.

For this analysis, visits with an International Classification of Diseases, Ninth Revision, Clinical Modification code indicating a physician diagnosis of IBS and those where an IBS-related symptom was listed as the reason for the visit were classified as encounters for IBS-related care.

The data were weighted to produce national estimates of the frequency of IBS-related visits, patient characteristics, and associated management strategies across three 6-year timeframes (1993-1998; 1999-2004; 2005-2010). The frequency of visits, patient characteristics, and treatment patterns were compared between periods.

A total of 1024 records (representing a weighted estimate of 27 million patient visits) were examined during the study. From 1993 through1998 and 2005 through 2010, the rate of physician visits related to IBS decreased by approximately 37% (P<.01). There was no difference between time periods in the estimated proportion of IBS subtypes (IBS-diarrhea [IBS-D], IBS-constipation [IBS-C]).

Over time, patients were more likely to receive at least 1 nonmedication therapy (diet/nutrition counseling, mental health counseling, and/or stress management) (2.5% to 12.3%; P<.001) and at least 1 medication (24.8% to 33.3%; P<.001).

There was increased use of gastrointestinal-specific antibodies, laxatives, proton pump inhibitors, antiemetics, bile acid sequestrants, opioid and nonopioid analgesics, and probiotics during the study period, as well (P<.001 for all). There was decreased use of fiber (P<.001), antidepressants (P=.002), antacids (P=.01), and histamine-2 receptor antagonists (P<.001).

In summary, the authors said, “IBS remains a common reason for outpatient office visits. However, from 1993 through1998 and 2005 through 2010, the rate of IBS-related office visits decreased by roughly one third. It appears that more visits are for IBS-D than IBS-C, although this is a rough estimate. Over time, visits were more likely to result in medication therapy.”