The Management of Irritable Bowel Syndrome: The Viewpoint of Italian General Practitioners in Activity and in Training

Research Article

J Fam Med. 2021; 8(6): 1264.

The Management of Irritable Bowel Syndrome: The Viewpoint of Italian General Practitioners in Activity and in Training

Bellini M1, Tosetti C2, Rettura F1*, Morganti R3, Lambiase C1, Visaggi P1, Pancetti A1, Benedetto E7, de Bortoli N1, Marchi S1 and De Bastiani R2

1Department of Translational Research in Medicine and Surgery, University of Pisa, Italy

2Italian Group for Primary Care Gastroenterology, General Practitioner and Gastroenterologist, National Health Service, Italy

3Clinical Trial Statistical Support Unit, Azienda Ospedaliero Universitaria Pisana, Italy

*Corresponding author: Rettura F, Department of Translational Research in Medicine and Surgery, University of Pisa-Ospedale Cisanello, Gastroenterology Unit, Via P. Trivella, 56124 Pisa, Italy

Received: June 16, 2021; Accepted: July 02, 2021; Published: July 09, 2021


Background: Guidelines on Irritable Bowel Syndrome (IBS) are usually developed by specialists, with a possible translational gap in primary care.

Aims: To evaluate the knowledge of IBS of Italian General Practitioners (GPs) and the difference compared to doctors in Training for General Practice (ITGPs).

Methods: A questionnaire was completed by 170 GPs and 64 ITGPs.

Results: The Rome Criteria and Bristol Scale are more familiar to ITGPs than GPs. The most frequently used diagnostic symptoms are abdominal pain, bowel movement frequency and bloating. GPs and ITGPs think that bloating and abdominal discomfort should be introduced into the definition of IBS. Intestinal motility disorders and psychological factors are considered to be the most probable cause of IBS. GPs report more frequently than ITGPs that the patient's request and difficulties in managing the disorder are reasons for a gastroenterological referral.

Conclusions: There is still a gap between the indications provided by the experts and clinical practice, and this seems greater on the part of GPs than ITGPs. Abdominal pain and bowel frequency changes are considered the main symptoms for diagnosing IBS, but most GPs and ITGPs would like to include bloating among the diagnostic criteria. It would be highly desirable to develop commonly shared guidelines between gastroenterologists and GPs.

Keywords: Irritable bowel syndrome; General practitioners; Primary care


Irritable Bowel Syndrome (IBS) represents one of the most frequent gastroenterological clinical problems both for specialists and General Practitioners (GPs) [1-5]. As for the other functional disorders, the complex and multifaceted pathophysiological aspects often lead to iteration of unnecessary medical examinations and diagnostic tests and to a multiplicity of therapeutic suggestions, which are sometimes contradictory and conflicting. It is therefore not surprising that the management of IBS patients is frequently unsatisfactory [6,7]. The IBS definition itself is still under discussion, so even the diagnostic criteria internationally proposed by gastroenterologists, such as the Rome IV Criteria (RC) [8], are often scarcely used in clinical practice by gastroenterologists themselves, even if they remain a cornerstone of research studies [9]. In addition, since most of the guidelines and position papers published on this topic have been conceived within a gastroenterological setting, it is likely that a translational "gap" exists with primary care, possibly inducing a certain inertia both in the diffusion and in the acceptance of such criteria by the GPs [10]. This is even more important in the Italian primary care setting where most GPs have had many years of activity. This means that they could very well be anchored to their professional routine, or simply resistant to changes, also considering that in the last ten years there have been no decisive and substantial changes in the diagnostic and therapeutic approach to IBS. Conversely, young doctors still in Training for General Practice (ITGPs), who are partially included in an educational circuit in close connection also with specialists, could be provided with more up-to-date knowledge and could have these concepts integrated into their professional practice.

The aim of the present study was to evaluate the knowledge and the use of the diagnostic and management criteria for IBS in a group of Italian GPs and ITGPs.

Materials and Methods

The survey was carried out in October 2019 in three cities located in the North, in the Center and in the South of Italy. An invitation to participate in the study was sent to 300 GPs randomly selected from the lists and 90 ITGPs attending the final year of their course.

The invitation was accompanied by the description of the purpose of the survey and the link to an online form. The form was totally anonymous without any possibility of identifying the participants. The access to the form was authorized only upon an express declaration of consent to participate.

The form contained demographic information such as age, gender, years since graduation (≤20 years vs. >20 years) and number of patients (≤1000 vs. >1000) under their care. Respondents were required to answer about their knowledge and use of the RC and of the Bristol Scale (BS) for the determination of fecal consistency, and on the symptoms considered fundamental for the diagnosis of IBS. They also had to assess (improbable vs. probable) the relevance of the possible causes of IBS and the reasons for the possible referral to a gastroenterologist.

Respondents were finally required to rate the percentage of patients in whom satisfactory IBS management defined as ‘a patient who perceives her/his symptoms as no more than a nuisance and rejoins that silent majority of people with IBS who do not seek health care’ [10] could be achieved, make a judgement about their overall knowledge of IBS (satisfactory/unsatisfactory) and assess their needs for further specific professional education (yes/no).

The investigation was carried out according to the principles of the Helsinki Declaration. The approval of an Ethics Committee was not required, according to national legislation, given that this was an anonymous survey among professionals.

Statistical methods

Categorical data were described by absolute and relative frequency, continuous data by mean and standard deviation. To analyze qualitative and quantitative factors the chi square test or z-test for two proportions and t-test for independent samples (two tailed) were performed, respectively. Multivariate models based on logistic regression were applied to compare independent variables with one specific dependent variable. Significance was fixed at 0.05. All analyzes were carried-out by SPSS vs. 26 technology.


One hundred and seventy GPs (56.7%) and 64 ITGPs (71.1%) participated in the survey. The two groups showed significant differences not only with respect to age (p=0.001), years since graduation (p=0.001) and specialization in gastroenterological disciplines (p=0.002), but also as regards their distribution by sex, the ITGPs being more frequently female than the respondent GPs (p=0.001) (Table 1).