Conflict of interest: A.J.P.M. Smout received remuneration for consultancy from Xenoport Inc., and royalties for a textbook on internal medicine. The Netherlands Society of Occupational Medicine (NVAB), where C.T.J. Hulshof works, received a subsidy for supporting the project ‘Guidelines for work’ (Arbeid in richtlijnen) from the Dutch Ministry for Social Affairs and Employment. The institute where N.J. de Wit works received grants for the research projects ‘Efficiency and Prevention’ (Doelmatigheid en Preventie) and ‘In line with each other’ (Op één lijn) from the Netherlands institute for health research and development (ZonMw), and funds for an e-learning module about IBS from the European Society for Primary Care Gastroenterology.
Financial support for this article: H. Woutersen-Koch’s employer received a subsidy for the development of the IBS guideline from the ZonMw programme ‘ Quality of Curative Care Knowledge Policy’ (KKCZ). Hulshof’s institute received travelling expenses for meetings and an attendance fee for review activities from the NVAB. The institute where N.J. de Wit works received a subsidy for an RCT into fibres in IBS (Fibre study) from ZonMw-Commonplace Illnesses, a grant for diagnostic research into distinguishing between abdominal complaints of organic and non-organic origin (CEDAR study) from ZonMw-Efficiency and a grant for a comparative study into the experience of patients and doctors around IBS in the United Kingdom and the Netherlands from the European Society Primary Care Gastroenterology. The institute where H.E. van der Horst works received an attendance fee for meetings from ZonMw-KKCZ via the NHG.
The multidisciplinary guideline ‘Diagnostics and treatment of irritable bowel syndrome (IBS)’ provides the basis for a properly coordinated collaboration between the patient suffering from IBS and all healthcare providers involved in his or her treatment, such as the general practitioner, gastroenterologist, internist, occupational-health physician, dietitian and psychologist.
The diagnosis ‘IBS’ is often made in accordance with diagnostic criteria, such as the Rome III criteria, but a somatic condition needs to be excluded first. If there are no indications for this, additional diagnostic tests are not necessary.
Management of the condition consists primarily of advice on life-style plus non-pharmacological interventions, in addition to explaining the condition and providing information. Drug treatment is rarely indicated.
If the IBS symptoms have a significant impact on quality of life and patients do not respond to the measures taken in accordance with this general policy, there are three options for psychotherapeutic treatment.
When the symptoms result in absenteeism or other work-related problems, the doctor can advise the patient to contact the occupational-health physician and to search for specific solutions in consultation with the employer.
When individual advice is required or if the patient’s diet is not well-balanced, a referral to the dietitian will follow.