New clinical algorithms will give physicians a practical, efficient and cost-effective aid to diagnose the frequent gastrointestinal symptoms that patients commonly bring to their primary care doctors and gastroenterologists--symptoms of functional GI disorders that are often difficult to diagnose.
Developed by the Rome Foundation and published in the April issue of The American Journal of Gastroenterology, the new tool, Diagnostic Algorithms for Common Gastrointestinal Symptoms, provides an evidence-based approach to the diagnosis of functional gastrointestinal disorders, including irritable bowel syndrome (IBS) and functional dyspepsia, by providing diagnostic pathways for common symptoms such as abdominal pain, nausea and vomiting, diarrhea and constipation. These diagnostic algorithms are based on the consensus of international experts, use standard methods and yes-no decision trees, and all end in specific diagnoses, providing clinicians with the best diagnostic strategies currently available.
"Functional gastrointestinal disorders are among the most commonly seen chronic disorders in clinical practice, affecting all regions of the digestive tract and comprising about 40 percent of gastroenterologists' diagnoses," explained Douglas A. Drossman, MD, FACG who is president of the Rome Foundation and Co-Director, UNC Center for Functional GI and Motility Disorders, at the University of North Carolina at Chapel Hill.
"Patient's don't go to their doctors complaining of IBS, or Sphincter of Oddi dysfunction," said Drossman. "They present with symptoms of abdominal pain, nausea, vomiting and constipation among others."
Accordingly, the Rome Foundation's objective for the new algorithms is a symptom-based diagnostic assessment of 15 of the most common GI symptoms that patients bring to primary care physicians as well as gastroenterologists.
"Efficient diagnoses can be challenging especially since the symptoms for these disorders often mimic one another, and arise from several areas of the GI tract," said guest editor John E. Kellow, MD, Associate Professor of Medicine, University of Sydney and Director, Gastrointestinal Investigation Unit, Royal North Shore Hospital, Sydney, Australia.
"Not only do many of these conditions lack reliable clinical signs, but also they do not exhibit structural change or biochemical abnormalities," said Kellow. "As a result, many clinicians avoid making a formal diagnosis of a specific functional GI disorder, either categorizing the disorder as 'functional', or diagnosing a wide range of disorders and symptoms as 'irritable bowel.'"
"The diagnosis of functional GI disorders should not be considered merely one of exclusion," said Kellow. "Diagnosis involves a guided algorithmic approach in order to move from symptoms to diagnosis, be it disease or symptom."
The Rome Foundation has for years recognized the limitations of the diagnostic criteria for functional GI disorders they developed known widely as "the Rome Criteria" -a standardized classification system for the functional GI disorders, which, until now, did not include a clinical application component. The new diagnostic tool is the result of a two-year collaborative process that incorporates symptom-based criteria and other diagnostic information into clinical algorithms that can be easily understood and applied in the clinical setting.
"These new algorithms offer the chance to advance the diagnostic capabilities of gastroenterologists and other healthcare practitioners by providing a clear and evidence-based roadmap to make a specific diagnosis when it comes to complex functional GI disorders," said Philip O. Katz, MD, FACG, President, American College of Gastroenterology. "Ultimately these tools will have the potential to improve the patient's experience and provide opportunities to reduce excessive testing and office visits in a quest for a definitive diagnosis and relief from their symptoms."
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