Fructose and glucose supplementation for the development of NAFLD and NASH in mice

Introduction: Irritable bowel syndrome (IBS) represents the most common disorder of gut-brain interaction encountered in clinical practice. The Rome IV criteria define the disorder. Over the years, many guidelines proposed guidance during the diagnostic and therapeutic approach of patients with presumed IBS.
Aim: This study explores habits in the management of IBS in daily practice and confronts these with the recently published recommendations of the Belgian IBS consensus.
Methods: We conducted an online survey exploring the diagnostic and therapeutic approach of patients suffering from IBS with predominant diarrhea (IBS-D) in primary and secondary care using an online vignette-based survey in Dutch and French between January and July 2022.
Results: Sixty-four gastroenterologists and 31 general practitioners completed the survey. Abdominal pain and abdominal discomfort as cardinal symptom resulted in a diagnosis of IBS by resp. 88% and 84%. Diagnostic workup usually consists of biochemical testing (85%), fecal blood test (48%), stool analysis for Clostridioides and parasites (64%). Only one out of five respondents test for coeliac disease and hyperthyroidism. 18% order breath testing. In the older patient case, 25% plan a colonoscopy with biopsies. Antispasmodics (28%) and dietary interventions (20%) represent the preferred
first-line treatment. In case of refractory symptoms, 58% of general practitioners refer the patient to a specialist. 20% of gastroenterologists start a neuromodulator and 13% initiate bile acid sequestrants in second and third line.
Conclusions: Contrasting with the ROME IV criteria, healthcare practitioners make no distinction between abdominal pain and discomfort when considering a diagnosis of IBS. Most physicians order only limited additional non-invasive testing, as recommended by the guidelines. In contrast to the recommendations, breath testing is frequently ordered. Antispasmodics and dietary interventions represent the preferred first-line treatment options. Management appears highly variable upon failure of initial treatment. Education should target the observed discrepancies with existing recommendations.