It has previously been shown that the panel of practices included in the Disease Analyzer database is representative of general and specialized practices in Germany. In Germany, the sampling methods used to select physicians' practices are appropriate for obtaining a representative database of general and specialized practices. Diagnoses (according to International Classification of Diseases, 10th revision ), prescriptions (according to Anatomical Therapeutic Chemical Classification system), and the quality of reported data are being monitored by IQVIA. The database covers approximately 3% of all outpatient practices in Germany. This study was based on data from the Disease Analyzer database (IQVIA), which contains drug prescriptions, diagnoses, and basic medical and demographic data obtained directly and in anonymous format from computer systems used in the practices of general practitioners and specialists. In the present study, we analyzed the proportion of patients with a diagnosis of IBS who, within one year prior to the diagnosis of IBS, received a diagnosis of another gastrointestinal disease that is in principle capable of causing symptoms that also fit IBS and might therefore have precluded the diagnosis of IBS. It is therefore likely that the prevalence of IBS in Germany, reported at 1.34% in 2017, is overestimated given the current definition of IBS. Nevertheless, in many cases suspected for an IBS, complaints are less specific and it is difficult to decide whether an IBS or another disease is responsible for the patients’ symptoms. According to the current S3 guideline, irritable bowel syndrome (IBS) disease is present when all 3 items are met: (1) there are chronic symptoms, i.e., lasting longer than 3 months (e.g., abdominal pain, flatulence), which are referred to the intestine by the patient and the physician and are usually accompanied by changes in bowel movements (2) the complaints should justify the patient seeking help and/or worrying about them and be so severe that the quality of life is relevantly impaired as a result (3) there are no characteristic alterations for other clinical pictures which are probably responsible for these symptoms. Various terms have since been used in the literature since then, however, the designation “irritable bowel syndrome” has become established in nowadays for the disease. The term “spastic colon” or "irritable colon" was used by Ryle in 1928 as well as Jordan and Kiefer in 1929, respectively, who described a musculo-neural disorder of the colon in 30% of gastroenterological outpatients with abdominal pain and impaired defecation. In 1892, Osler and Hurst described a "mucous colitis" with discharge of mucus (mucorhea), cellular debris, and "intestinal sand".
Moreover, we show that IBS is frequently diagnosed in patients with preexisting GI diseases, potentially putting into question the validity of IBS diagnosis at least in some cases.Īs early as 3000 years ago, Hippocrates described a patient with abdominal complaints, altered stool behavior, flatulence and urge to defecate. Our data provide evidence for a high overlap between IBS and other GI diagnoses. Additionally, 12,048 (41%) received one of these diagnosis within 12 months after the first IBS diagnosis. Most common overlapping diagnoses were intestinal infectious diseases (26%), gastritis/ duodenitis (21%), diseases of the esophagus (15%), non-infectious enteritis or colitis (7.4%), functional dyspepsia (6%) and ulcers (1.0%).
Notably, 16,164 (55%) of these patients had at least one preexisting diagnosis of another GI diseases within 12 months prior to the first IBS diagnosis. Out of these, 29,553 patients had an observation time of at least 12 months prior to the first IBS diagnosis and at least 12 months after the first IBS diagnosis. ResultsĦ5,569 patients with an initial diagnosis of IBS were included into the analysis. Using the Disease Analyzer database (IQVIA) featuring patients treated within 20 within 1240 general practices in Germany, we analyzed the prevalence of common GI diseases within 12 months prior to and after the first diagnosis of IBS. Many patients with IBS display complex gastrointestinal (GI) symptoms leading to overlapping diagnosis of IBS and other GI diseases in many patients.
Irritable bowel syndrome (IBS) represents the most common functional disorder of the gastrointestinal tract.
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