Declining Rates of Referral for Irritable Bowel Syndrome Without Constipation at a Tertiary Care Center
Irritable bowel syndrome (IBS) is a common chronic disorder of the gastrointestinal tract. Several treatments have been developed, including rifaximin for the treatment of IBS without constipation (non-IBS-C), but no studies have evaluated the effect of these therapies on patient referral rates to tertiary care gastroenterology clinics.
To assess referral patterns for IBS patients at a tertiary motility clinic over a 10-year period.
Data from consecutive patients referred to the clinic during 2006–2016 were analyzed. Trends in the proportion of referrals and prior rifaximin use in IBS-C versus non-IBS-C groups were compared.
A total of 814 adult patients were referred to a single physician panel for IBS-related symptoms. Of these, 776 were included in the study [528 females (68%), average age 45.7 ± 15.9 years), comprising 431 IBS-C (55.5%) and 345 non-IBS-C (44.5%) patients. The proportion of non-IBS-C referrals declined significantly from 53.0% in 2006 to 27.3% in 2016 (Chi-square, p < 0.0001, Cochran–Armitage trend test p = 0.0001), and the proportion of IBS-C referrals increased significantly from 46.9% in 2006 to 72.7% in 2016 (Chi-square, p < 0.0001, Cochran–Armitage trend test p = 0.0004). Non-IBS-C referrals with prior rifaximin use significantly increased from 22.7% in 2006 to 66.7% in 2016 (Cochran–Armitage trend test, p = 0.008).
The results indicate a significantly declining tertiary care referral rate for non-IBS-C over the past decade. While not directly linked, there has been an increase in rifaximin use in the same population during the same time interval.
KeywordsIrritable bowel syndrome Diarrhea Constipation Referral rates Rifaximin
Compliance with ethical standards
Conflict of interest
Cedars-Sinai has licensing agreements with Salix Pharmaceuticals, Naia Pharmaceuticals, Gemelli Biotech, Inc., and Synthetic Biologics Inc. Mark Pimentel is a consultant for Salix Pharmaceuticals, Naia Pharmaceuticals, Synthetic Biologics Inc., Shire, and US Medical, is a board member of Gemelli Biotech and has received research funding from Salix Pharmaceuticals and Synthetic Biologics Inc. Ruchi Mathur is a board member of Gemelli Biotech and has received research funding from Valeant Pharmaceuticals and the American Diabetes Association. Ali Rezaie has received speaker and consultant fees from Commonwealth Laboratories, Actavis, and Salix Pharmaceuticals, and has received research funding from Valeant Pharmaceuticals, the American College of Gastroenterology, and the Kenneth Rainin Foundation. The remaining authors have no conflicts to disclose.
- 7.Pimentel M. Evidence-based management of irritable bowel syndrome with diarrhea. Am J Managed Care. 2018;24:S35–S46.Google Scholar
- 10.FDA Drug Safety Communication. FDA warns about increased risk of serious pancreatitis with irritable bowel drug Viberzi (eluxadoline) in patients without a gallbladder. Silver Spring: Food and Drug Administration; 2017.Google Scholar