Racial Disparities in the Diagnosis and Management Between Secondary Care Ethnic Minority and White British Patients With Irritable Bowel Syndrome

Abstract

Background: Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut-brain interaction best understood within a biopsychosocial framework. Recent studies in other healthcare systems have suggested racial disparities in the management of IBS.

Aims: We aimed to investigate racial disparities in the diagnosis and management of IBS including adherence to national guidelines between White British and Ethnic minority patients with IBS in a UK secondary care setting.

Methods: Consecutive Ethnic minority patients (N = 68) with a coded secondary care diagnosis of IBS at a gastroenterology department in a large UK teaching hospital were identified from electronic health records. Data on diagnostic pathways and access to treatments and adherence to national guidelines were compared statistically with an equal number of age and gender matched white British controls (N = 68).

Results: Compared to age and gender matched White British controls, Ethnic Minority patients saw more clinicians (p = 0.012) and required more outpatient appointments to make an IBS diagnosis (p = 0.007). There were disparities identified in the approach to treatment, with ethnic minority patients less likely to be recommended second-line pharmacological treatment (p = 0.004) and Brain-Gut Behavioral Therapies (p = 0.005) compared to their White British counterparts. Across both groups, adherence to national guidelines in the diagnostic approach and treatment for IBS was low, with most patients not being recommended second-line medical, dietary, or behavioral treatment for their IBS.

Conclusions: These data suggest that the management of IBS in secondary care in the UK has not kept pace with advances in evidence-based treatments and updated guidelines. Moreover, racial disparities, whether influenced by clinicians or patients, were seen between the two ethnic groups regarding the diagnosis and management of IBS. Further studies are necessary to determine the barriers contributing to these disparities, to influence future interventions and clinical training to address them.

Keywords: disorders of gut‐brain interaction; irritable bowel syndrome; racial disparities.