Irritable Bowel Syndrome: Jones R

Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill N, Whorwell P, Anonymous00175. · Wolfson Digestive Diseases Centre, University of Nottingham, Nottingham, UK. · Gut. · Pubmed #17488783 No free full text.

Abstract: BACKGROUND: IBS affects 5-11% of the population of most countries. Prevalence peaks in the third and fourth decades, with a female predominance. AIM: To provide a guide for the assessment and management of adult patients with irritable bowel syndrome. METHODS: Members of the Clinical Services Committee of The British Society of Gastroenterology were allocated particular areas to produce review documents. Literature searching included systematic searches using electronic databases such as Pubmed, EMBASE, MEDLINE, Web of Science, and Cochrane databases and extensive personal reference databases. RESULTS: Patients can usefully be classified by predominant bowel habit. Few investigations are needed except when diarrhoea is a prominent feature. Alarm features may warrant further investigation. Adverse psychological features and somatisation are often present. Ascertaining the patients' concerns and explaining symptoms in simple terms improves outcome. IBS is a heterogeneous condition with a range of treatments, each of which benefits a small proportion of patients. Treatment of associated anxiety and depression often improves bowel and other symptoms. Randomised placebo controlled trials show benefit as follows: cognitive behavioural therapy and psychodynamic interpersonal therapy improve coping; hypnotherapy benefits global symptoms in otherwise refractory patients; antispasmodics and tricyclic antidepressants improve pain; ispaghula improves pain and bowel habit; 5-HT(3) antagonists improve global symptoms, diarrhoea, and pain but may rarely cause unexplained colitis; 5-HT(4) agonists improve global symptoms, constipation, and bloating; selective serotonin reuptake inhibitors improve global symptoms. CONCLUSIONS: Better ways of identifying which patients will respond to specific treatments are urgently needed.

Jones R. · No affiliation provided · BMJ. · Pubmed #19008267 No free full text.

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Jones R. · No affiliation provided · Br J Gen Pract. · Pubmed #15239907 links to  free full text

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El-Serag H, Hill C, Jones R. · Michael E DeBakey Department of Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA. · Aliment Pharmacol Ther. · Pubmed #19035977 No free full text.

Abstract: BACKGROUND: Gastro-oesophageal reflux disease (GERD) is a common diagnosis in primary care; however, there has been no comprehensive review of the epidemiology of GERD in this setting. AIM: To review systematically articles that used the General Practice Research Database to study the epidemiology of GERD. METHODS: Systematic literature searches. RESULTS: Seventeen articles fulfilled the inclusion criteria. The incidence of GERD in primary care was 4.5 new diagnoses per 1000 person-years in 1996 (95% CI: 4.4-4.7). A new diagnosis of GERD was associated with being overweight, obese or an ex-smoker. Prior diagnoses of ischaemic heart disease, peptic ulcer disease, nonspecific chest pain, nonspecific abdominal pain, chronic obstructive pulmonary disease and asthma were associated with a subsequent new GERD diagnosis. A first diagnosis of GERD was associated with an increased risk of a subsequent diagnosis of oesophageal adenocarcinoma, oesophageal stricture, chronic cough, sinusitis, chest pain, angina, gallbladder disease, irritable bowel syndrome or sleep problems. Mortality may be higher in patients with a GERD diagnosis than in those without in the first year after diagnosis, but not long term. CONCLUSION: The General Practice Research Database is an effective way of studying the epidemiology of GERD in a large population-based primary care setting.

Jones R. · Department of General Practice and Primary Care, King's College London, London, UK. · Nat Clin Pract Gastroenterol Hepatol. · Pubmed #17534282 No free full text.

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Quigley EM, Bytzer P, Jones R, Mearin F. · Alimentary Pharmabiotic Centre, Department of Medicine, National University of Ireland, Cork University Hospital, Wilton, Cork, Ireland. · Dig Liver Dis. · Pubmed #16807154 No free full text.

Abstract: Irritable bowel syndrome affects approximately 10-15% of the European population, although prevalence rates vary depending on the classification used and the country surveyed. This may be due to differences in patterns of medical care and diagnosis of the condition. Up to 70% of individuals with irritable bowel syndrome may not have been formally diagnosed. The disorder affects 1.5-3 times as many women as men and poses a significant economic burden in Europe, estimated at euro 700-euro 1600 per person per year. It also reduces quality of life and is associated with psychological distress, disturbed work and sleep, and sexual dysfunction. It is a chronic disorder, which affects many individuals for more than 10 years. Most patients are managed in primary care, although some are referred to gastroenterologists and other specialists. Patients with irritable bowel syndrome undergo more abdomino-pelvic surgery than the general population. We propose that a positive diagnosis of the condition may avoid the delay in diagnosis many patients experience. We conclude that, in Europe, there are significant unmet needs including lack of familiarity with irritable bowel syndrome, difficulties in diagnosis and lack of effective treatments for the multiple symptoms of the disorder. The development of pan-European guidelines for irritable bowel syndrome will benefit patients with this condition in Europe.

de Wit N, Rubin G, Jones R. · Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg, Utrecht, The Netherlands. · Clin Evid. · Pubmed #16135274 No free full text.

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Kennedy T, Rubin G, Jones R. · Department of General Practice, Guy's, King's, and St Thomas's Medical School, King's College, London, UK. · Clin Evid. · Pubmed #15865669 No free full text.

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Kennedy T, Rubin G, Jones R. · Department of General Practice Guy's, King's, and St Thomas's Medical School King's College, London, UK. · Clin Evid. · Pubmed #15652025 No free full text.

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Rentz AM, Battista C, Trudeau E, Jones R, Robinson P, Sloan S, Mathur S, Frank L, Revicki DA. · Center for Health Outcomes Research, MEDTAP International, Inc, Bethesda, Maryland 20814, USA. · Pharmacoeconomics. · Pubmed #11383752 No free full text.

Abstract: Patient-rated symptom and health-related quality-of-life (HR-QOL) outcomes are important end-points for clinical trials of medical treatments for gastrointestinal (GI) disorders. Based on this review, patient outcomes research is focused on gastroesophageal reflux disease and dyspepsia, with a growing interest in irritable bowel syndrome but little research in gastroparesis. State-of-the-art for patient-rated symptom scales is rudimentary with an abundance of scales and little attention to systematic instrument development or comprehensive psychometric evaluation. Generally, disease-specific HR-QOL measures have been more systematically developed and evaluated psychometrically, but few have been incorporated into clinical trials. More comprehensive outcome assessments are needed to determine the effectiveness of new medical treatments for functional GI disorders. Future clinical trials of GI disorders should combine clinician assessments of outcomes and symptoms with patient-rated symptom and HR-QOL end-points.

Jones R. · Department of General Practice and Primary Care, Guy's, King's, and St. Thomas' School of Medicine, London, United Kingdom. · Am J Med. · Pubmed #10588178 No free full text.

Abstract: Approximately 15-20% of the general population of many western countries fulfill clinical diagnostic criteria for irritable bowel syndrome (IBS) and nearly 50% of referrals and follow-up appointments in hospital gastroenterology clinics are for functional bowel disorders. IBS is a common problem in the community, in primary care (general practice) and in secondary care (hospital, usually ambulatory) settings, and is also seen in tertiary (referral) centers, providing at least four potential settings for recruitment of patients into clinical trials. However, little is known about the influences that cause patients to choose different health-care settings or to stay away from the health-care system as "nonconsulters." Also, it is not known if patients seen at different health-care settings differ from each other. The aim of this review is to address the following questions: To what extent do subjects identified and enrolled in these settings differ from each other? What is the likely impact of different recruitment methods on subject selection? What problems for the interpretation and generalizability of data from clinical trials might these differences pose? What is the role of the sociomedical context (cultural beliefs and values and the structure of the health-care system) in different countries on the interpretation of clinical studies?

Kennedy T, Jones R, Darnley S, Seed P, Wessely S, Chalder T. · Department of General Practice and Primary Care, Guy's, King's, and St Thomas' School of Medicine, King's College, London SE11 6SP. · BMJ. · Pubmed #16093252 links to  free full text

Abstract: OBJECTIVE: To assess the efficacy of cognitive behaviour therapy delivered in primary care for treating irritable bowel syndrome. DESIGN: Randomised controlled trial. SETTING: 10 general practices in London. PARTICIPANTS: 149 patients with moderate or severe irritable bowel syndrome resistant to the antispasmodic mebeverine. INTERVENTIONS: Cognitive behaviour therapy delivered by trained primary care nurses plus 270 mg mebeverine taken thrice daily compared with mebeverine treatment alone. MAIN OUTCOME MEASURES: Primary measures were patients' scores on the irritable bowel syndrome symptom severity scale. Secondary measures were scores on the work and social adjustment scale and the hospital anxiety and depression scale. RESULTS: Of 334 referred patients, 72 were randomised to mebeverine plus cognitive behaviour therapy and 77 to mebeverine alone. Cognitive behaviour therapy had considerable initial benefit on symptom severity compared with mebeverine alone, with a mean reduction in score of 68 points (95% confidence interval 103 to 33), with the benefit persisting at three months and six months after therapy (mean reductions 71 points (109 to 32) and 11 points (20 to 3)) but not later. Cognitive behaviour therapy also showed significant benefit on the work and social adjustment scale that was still present 12 months after therapy (mean reduction 2.8 points (5.2 to 0.4)), but had an inconsistent effect on the hospital anxiety and depression scale. CONCLUSION: Cognitive behaviour therapy delivered by primary care nurses offered additional benefit over mebeverine alone up to six months, although the effect had waned by 12 months. Such therapy may be useful for certain patients with irritable bowel syndrome in primary care.

Jones R, Rubin G. · Department of General Practice and Primary Care, King's College London School of Medicine, London SE11 6SP. · BMJ. · Pubmed #19528114 No free full text.

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Jones R, Hunt C, Stevens R, Dalrymple J, Driscoll R, Sleet S, Blanchard Smith J. · Department of General Practice and Primary Care, King's College London. · Br J Gen Pract. · Pubmed #19520018 No free full text.

Abstract: BACKGROUND: Although gastrointestinal disorders are common in general practice, clinical guidelines are not always implemented, and few patient-generated quality criteria are available to guide management. AIM: To develop quality criteria for the management of four common gastrointestinal disorders: coeliac disease, gastro-oesophageal reflux disease (GORD), inflammatory bowel disease, and irritable bowel syndrome. DESIGN OF STUDY: Qualitative study including thematic analysis of transcripts from patient focus groups and content analysis of published clinical practice guidelines. Emergent themes were synthesised by a consensus panel, into quality criteria for each condition. SETTING: Community-based practice in England, UK. METHODS: Fourteen focus groups were conducted (four for coeliac disease, irritable bowel syndrome, and inflammatory bowel disease, and two for GORD) involving a total of 93 patients (64 females, 29 males; mean age 55.4 years). Quality criteria were based on patients' views and expectations, synthesised with an analysis of clinical practice guidelines. RESULTS: A chronic disease management model was developed for each condition. Key themes included improving the timeliness and accuracy of diagnosis, appropriate use of investigations, better provision of information for patients, including access to patient organisations, better communication with, and access to, secondary care providers, and structured follow-up and regular review, particularly for coeliac disease and inflammatory bowel disease. CONCLUSION: This study provides a model for the development of quality markers for chronic disease management in gastroenterology, which is likely to be applicable to other chronic conditions.

Jones R. · King's College London, Department of General Practice & Primary Care, London, UK. · Postgrad Med J. · Pubmed #18940946 No free full text.

Abstract: Gastrointestinal problems account for a significant proportion of general practitioners' workload, and gastrointestinal cancers, taken together, make up the largest group of malignancies. Approximately 10% of consultations in general practice in the UK are for gastrointestinal symptoms or problems, split roughly equally between the upper and lower gastrointestinal tract. Gastroenterology represents about 10% of the work of hospital specialists and the prescribing costs involved in the management of gastrointestinal disorders in general practice are around 14% of the drug budget. These disorders range from relatively minor and self limiting conditions such as acute gastritis and acute gastroenteritis, through the more significant, chronic digestive disorders such as gastro-oesophageal reflux disease (GORD), irritable bowel syndrome (IBS) and coeliac disease, to much more serious problems including inflammatory bowel disease (IBD) and upper gastrointestinal and colorectal cancer.

Seifert B, Rubin G, de Wit N, Lionis C, Hall N, Hungin P, Jones R, Palka M, Mendive J. · Department of General Practice, Charles University, Prague, First Faculty of Medicine, Prague, Czech Republic. · Dig Liver Dis. · Pubmed #18406672 No free full text.

Abstract: BACKGROUND: Gastrointestinal (GI) disorders account for 10% of all consultations in primary care. Little is known about the management of GI disorders by general practitioners (GP) across different European countries. AIM AND METHODS: We undertook a postal survey of randomly selected samples of GPs in six European countries (UK, Holland, Spain, Greece, Poland, Czech Republic) to determine patterns of diagnosis, management and service use in GI disorders. RESULTS: We received 939 responses, response rate 32%. Over 80% of GPs were aware of at least three national guidelines for gastrointestinal disease. The availability of open access endoscopy ranged from 28% (Poland) to over 80% (Holland, Czech and UK). For uninvestigated dyspepsia the preferred first line management was proton pump inhibitor therapy (33-82%), Helicobacter pylori test and treat (19-47%), early endoscopy (5-32%), specialist referral (2-21%). Regarding irritable bowel syndrome, 23% of respondents were familiar with one or more diagnostic criteria, but between 7% (Netherlands) and 32% (Poland) would ask for a specialist opinion before making the diagnosis. CONCLUSION: The wide variation between GPs both between and within countries partly reflects variations in health care systems but also differing levels of knowledge and awareness, factors which are relevant to educational and research policy.

McCrone P, Knapp M, Kennedy T, Seed P, Jones R, Darnley S, Chalder T. · Health Services Research Department, Centre for the Economics of Mental Health, School of Medicine, King's College, London, UK. · Eur J Gastroenterol Hepatol. · Pubmed #18334867 No free full text.

Abstract: OBJECTIVES: Irritable bowel syndrome is often treated in primary-care settings, and it has a relatively large economic impact. Cognitive behaviour therapy (CBT) in addition to mebeverine has been shown to be effective in the short term, compared with treatment with mebeverine alone. This study assesses the impact that CBT in addition to mebeverine has on resource use, and its cost-effectiveness. METHODS: Participants were recruited from general practices: those with ongoing symptoms were randomly allocated either to remain just on mebeverine or to receive CBT in addition to mebeverine. Service use and lost employment were measured at baseline and at the 3-month, 6-month and 12-month follow-ups. The net-benefit approach was used for combining the data on therapy costs and symptoms. RESULTS: The mean additional cost of CBT was pound 308. No significant impact of CBT on the use of other services or on lost employment was noted. The cost per clinically important reduction in symptoms was pound 220 by the end of treatment, pound 171 at the 3-month follow-up, pound 1027 at the 6-month follow-up and pound 3080 at the 12-month follow-up, for CBT in addition to mebeverine compared with mebeverine alone. CONCLUSIONS: CBT in addition to mebeverine seems to have reasonable cost-effectiveness in the short-term treatment of irritable bowel syndrome, but not beyond 3 months.

Wallander MA, Johansson S, Ruigómez A, García Rodríguez LA, Jones R. · AstraZeneca R&D Mölndal, Mölndal, Sweden. · Fam Pract. · Pubmed #17728288 links to  free full text

Abstract: BACKGROUND: Many individuals consulting their GP with upper abdominal symptoms are initially classified as having dyspepsia. Few studies have described the incidence of dyspepsia or the comorbidities, risk factors or prognosis associated with this diagnosis. METHODS: We used the UK General Practice Research Database to find patients with a new diagnosis of dyspepsia in 1996 (n = 6,913) and a control cohort (n = 11,036). We determined the incidence of dyspepsia, potential risk factors and comorbidity, and the risk of new onset morbidity in the year following the index date. RESULTS: The incidence of dyspepsia was 15.3 per 1,000 person-years. An increased probability of a dyspepsia diagnosis was associated with chest pain [odds ratio (OR): 2.4], general pain (OR: 1.8), sleep disorders (OR: 1.5), angina (OR: 1.5), osteoarthritis/rheumatoid arthritis (OR: 1.4) and smoking (OR: 1.2). There was only a borderline association with obesity (OR: 1.1). Patients with dyspepsia had an increased likelihood of a diagnosis of irritable bowel syndrome (IBS) (OR: 264), gastroesophageal reflux disease (GERD) (OR: 62.8) or peptic ulcer disease (PUD) (OR: 27.2) during the following year. CONCLUSIONS: The commonest diagnosis to emerge after an initial consultation for dyspepsia was IBS, followed by GERD and PUD.

Jones R, Latinovic R, Charlton J, Gulliford M. · Division of Health and Social Care Research, King's College London School of Medicine, London, UK. · Aliment Pharmacol Ther. · Pubmed #16918893 No free full text.

Abstract: BACKGROUND: Irritable bowel syndrome is a common problem known to have a complex relationship with psychological disorders and other physical symptoms. Little information, however, is available concerning physical and psychological comorbidity in irritable bowel syndrome patients studied over an extended period. AIM: To evaluate physical and psychological morbidity 2 years before and during 6 years after the time of diagnosis in incident cases of irritable bowel syndrome and control subjects. METHODS: A matched cohort study was implemented in 123 general practices using the General Practice Research Database. Irritable bowel syndrome cases (n = 1827) and controls (n = 3654) were compared for 2 years before and 6 years after diagnosis. RESULTS: The age-standardized incidence of irritable bowel syndrome in patients over 15 years of age was 1.9 per 1,000 in men and 5.8 per 1,000 in women. From 2 years before the date of diagnosis, more irritable bowel syndrome cases (13%) than controls (5%) consulted with depression or were prescribed antidepressant drugs. Consultation and prescription rates for anxiety were also higher before diagnosis, and both anxiety and depression remained prevalent up to 6 years after diagnosis. Asthma, symptoms of urinary tract infection, gall-bladder surgery, hysterectomy and diverticular disease were recorded more frequently in irritable bowel syndrome patients, who were also more likely than controls to be referred to hospital. CONCLUSIONS: People who are diagnosed with irritable bowel syndrome experience more anxiety and depression and a range of physical problems, compared with controls; they are more likely to be referred to hospital.

Kennedy T, Jones R. · Department of General Practice, Guy's, King's and St Thomas' School of Medicine, London, UK. · Aliment Pharmacol Ther. · Pubmed #11121906 links to  free full text

Abstract: BACKGROUND: Patients consulting with gastro-oesophageal reflux symptoms (GORS) may differ from nonconsulters. AIM: To describe these differences in a UK population. METHODS: A postal questionnaire was sent to 4432 adults. Definitions used were GORS (either heartburn or acid regurgitation on more than six occasions during the previous year), dyspepsia (upper abdominal pain or discomfort on more than six occasions during the previous year) and irritable bowel syndrome (abdominal pain with three or more Manning criteria). Socio-economic status was identified by the Standard Occupational Classification. RESULTS: With a 71.7% response, GORS were reported by 28.7% of the sample, it was unaffected by gender and age but was more common among the socially disadvantaged (P < 0. 005). Less than 25% of GORS patients consulted during the previous year. Increasing age (chi2 for trend; P < 0.001) and coexisting upper abdominal symptoms (chi2 P < 0.001) positively influenced consultation behaviour, but it was unaffected by socio-economic status, gender, or the coexistence of irritable bowel syndrome. Dyspepsia and nausea independently predicted consultation. CONCLUSIONS: GORS are especially common among the deprived. Socio-economic variables do not affect consultation behaviour, but the patient's age and the burden (number and type) of associated symptoms do.

Jones R, Rubin G. · No affiliation provided · Int J Clin Pract. · Pubmed #16862637 No free full text.

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