Declining Rates of Referral for Irritable Bowel Syndrome Without Constipation at a Tertiary Care Center

Dig Dis Sci. 2019 Jan;64(1):182-188. doi: 10.1007/s10620-018-5302-2. Epub 2018 Oct 15.


Background: 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.

Aim: To assess referral patterns for IBS patients at a tertiary motility clinic over a 10-year period.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Constipation; Diarrhea; Irritable bowel syndrome; Referral rates; Rifaximin.

MeSH terms

  • Adult
  • Aged
  • Drug Utilization Review / trends
  • Female
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Irritable Bowel Syndrome / diagnosis
  • Irritable Bowel Syndrome / drug therapy*
  • Irritable Bowel Syndrome / epidemiology
  • Los Angeles / epidemiology
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / trends*
  • Referral and Consultation / trends*
  • Retrospective Studies
  • Rifaximin / therapeutic use*
  • Tertiary Care Centers / trends*
  • Time Factors
  • Treatment Outcome


  • Gastrointestinal Agents
  • Rifaximin