How Nurse Practitioners Can Help Patients With Irritable Bowel Syndrome
Learn about the latest diagnostic tools and quality-of-life improvements available for patients living with this common gastrointestinal condition.
Across the United States, it is estimated that 25 to 45 million individuals are living with a chronic gastrointestinal (GI) condition that limits their ability to work, go to school, engage in social activities and maintain close relationships. Despite affecting 5 to 10% of the worldwide population, surveys suggest that up to 75% of individuals with this common disorder may be undiagnosed. Patients that do seek medical treatment may wait up to four years before seeing their health care provider. Those are the challenges faced by those living with irritable bowel syndrome (IBS) — a common disorder characterized by abdominal pain and altered bowel habits without any organic cause.
Although IBS does not shorten a patient’s lifespan, the negative effects of IBS symptoms and the high medical costs incurred while trying to treat the condition take a toll on patients’ quality of life. In fact, one study found that patients with IBS would be willing to decrease their life expectancy by 10 to 15 years if they could receive a cure for their symptoms. Since 1997, the International Foundation for Gastrointestinal Disorders (IFFGD) has observed IBS Awareness Month in April — giving patients and providers alike the opportunity to share important health messages about IBS diagnosis, treatment and quality-of-life issues. This April, join the American Association of Nurse Practitioners® (AANP) in discussing how nurse practitioners (NPs) can help patients navigate their IBS journey and improve their quality of life.
Recognizing and Navigating IBS
According to the IFFGD, patients seeking an IBS diagnosis may find that “the digestive system appears normal on routine tests. For this reason, it has been referred to as a functional GI disorder (FGID).” This is further confounded by the overlap between symptoms of IBS and other illnesses. As a result of this, the diagnosis of IBS has long been considered a diagnosis of exclusion — requiring patients to undergo a variety of tests to exclude all other diagnosis before arriving at IBS. That changed in 2021, when the American College of Gastroenterology (ACG) released their first-ever clinical guidelines for the diagnosis of IBS reflecting a positive diagnostic strategy instead of a diagnosis of exclusion. With this approach, providers can drastically reduce the time from diagnosis to treatment and reduce unnecessary testing and health care costs, all the while improving health outcomes.
But how can NPs identify and positively diagnose a condition which eludes so many tests? AANP’s IBS Point of Care Tool describes one of the primary methods of diagnosing IBS — the Rome IV criteria: “Rome IV defines IBS as an FGID in which recurrent abdominal pain is associated with defecation or a change in bowel habits.” If you are looking out for symptoms of IBS in your patients, ask if they’ve experienced recurrent abdominal pain on average of at least one day a week in the last three months (symptom onset greater than or equal to 6 months before diagnosis) and two or more of the following: related to defecation, associated with a change in stool frequency or associated with a change in stool form (appearance). NPs seeking more information on diagnostic criteria and algorithm, the Bristol Stool Form Scale (BSFS), IBS subtypes, laboratory testing, alarm features, first-line therapies and more can refer to the Navigating IBS Diagnosis and Treatment tool in the AANP Gastroenterology resources page.
Improving Quality of Life for Patients with IBS
As stated in the IBS Point of Care tool, “IBS treatment aims to alleviate symptoms and improve quality of life.” Although IBS is a chronic condition, patients can find improvement in their symptoms with lifestyle changes, over-the-counter medications and prescription medications. However, the symptomology of IBS is complex, and every patient with IBS will have different needs. How can providers determine the best treatment plan for their patients?
While lifestyle and dietary modifications are recommended for all patients with IBS, providers must consider a more targeted and personalized approach when prescribing medications for these patients. As per the Point of Care tool, “When selecting pharmacologic agents, the provider needs to consider the physiologic mechanisms of IBS and the psychosocial factors contributing to the patient's symptoms.” The tool elaborates on this further, stating “Given IBS's associated gut-brain axis pathophysiology, providers must consider when to target treatment toward the gut, the brain or both.” In order to help your patients with the treatment and management of their condition, share the Improving Quality of Life With Irritable Bowel Syndrome patient handout in the AANP Gastroenterology resources page and discuss the benefits of keeping a symptom diary to gain a better understanding of their IBS.
Explore Gastroenterology Tools and Resources From AANP
AANP offers a variety of gastroenterology tools and resources designed to keep you informed on important health issues and assist you in educating your patients. Browse the AANP Gastroenterology Resources page to access IBS point-of-care tools, continuing education and patient handouts to support your success.