M1815 More Than Just GERD: Obstructive Sleep Apnea Is Associated with IBS and Constipation

Abstract

diagnosis of IBS has not been well studied. Aim: To assess the frequency with which primary care physicians (PCPs) and Gastroenterologists (GIs) appropriately document ‘red flags' and utilize colonoscopy in the diagnosis of IBS. Methods: We identified 100 cases of potential newly diagnosed IBS by appropriate ICD codes and typical IBS symptoms (modified Rome III). A detailed review of the medical record was subsequently performed by two independent reviewers (BHH, PR) for documentation of the presence or absence of the following ‘red flags': weight loss, blood in stools, nocturnal symptoms, abnormal physical exam, family history of colon cancer or inflammatory bowel disease, recent antibiotic use. Colonoscopy utilization and results were also recorded. Results: All 6 ‘red flags' were documented in only 7% of the patients. The specific percentages of each ‘red flag' were as follows: weight loss (74%), blood in stools (91%), nocturnal symptoms (26%), abnormal physical exam (98%), family history (52%), recent antibiotic use (24%). The number of red flags excluded was similar whether the diagnosis was made by PCP or GI. Lower endoscopy (sigmoidoscopy or colonoscopy) was performed in 72 out of the 100 patients. Of the patients who underwent endoscopy, 27% were over the age of 50, however, 31% under the age of 50 had no documented ‘red flags'. In only 1 patient did the endoscopy change the diagnosis of IBS (to Ulcerative Colitis). Themost common colonoscopy findings were hemorrhoids (36%), normal (31%), polyps (17%), diverticulosis (14%) and fissures (1%). Conclusions: Despite established guidelines recommending the exclusion of ‘red flags' in diagnosing IBS, physicians are not routinely documenting the presence or absence of them. Roughly one-third of lower endoscopies were performed without appropriate documentation of ‘red flags' in patients under 50. Further education of the importance of discussing and documenting ‘red flags' in the diagnosis of IBS is warranted.