Review for 10.1186/1471-230X-1-11 (2001)

Reviewer's□report 
□Do□published□guidelines□for□evaluation□of□Irritable□Bowel□Syndrome□reflect□practice? Title: 
Authors: 
Barbara□P□Yawn□( yawnx002@tc.umn.edu )
Eva□Lydick□( eva.lydick@astrozeneca.com )
G.□Richard□Locke□III□( locke.giles@mayo.edu )
Peter□C.□Wollan□( wollan@mayo.edu )
Susan□L.□Bertram□( vtail4fun@aol.com )
Margary□J.□Kurland□( Mkurland@olmmed.org )
□2□ □16□Aug□2001 Version: Date: 
□Dr□Martin□Mahoney Reviewer: 
□A□paper□whose□findings□are□important□to□those□with□closely□related□research□interests Level□of□interest: 
□Accept□after□revision,□which□I□do□not□need□to□see Advice□on□publication: 
interesting□report□on□condition□frequently□encountered□in□family□practice.□Suggestions□for□some□modest□ 
reformating□to□clarify/highlight□important□findings□are□suggest□below.□ 
1.□given□the□unique□epidemiologic□database□in□Olmstead□County□(MN),□is□it□possible□to□calculate□an□ 
incidence□rate□for□IBS□?□ 
2.□page□5□-□what□is□the□size□of□the□Olmstead□MSA?□ 
3.□page□5,□line□#6□-□.....are□likely□to□reflect□the□clinical□experience□of□these□specialists........"□ 
4.□page□8.□edit□section□on□data□analysis□into□separate□paragraphs;□this□section□is□a□run-on.□ 
5.□page□8□&□table□2.□suggest□use□of□term□"immediate□diagnosis□period"□and□"extended□diagnosis□period"□ 
to□more□clearly□differentiate□this□two□time□frames.□ 
6.□page□9,□paragraph□#2,□line□3□-□since□most□IBS□diagnoses□were□made□by□primary□care□physicians□what□ 
is□breakdown□for□GP/FP/IM/Ob-Gyn/others?□Did□the□work-up□vary□by□specialty?□ 
7.□can□"primary□care"□be□considered□equivalent□to□"family□practice"□(this□is□somewhat□of□a□rhetorical□ 
question........see□above)□ 
8.□page□9□and□table□2□-□suggest□reformatting□table□to□more□closely□match□information□presented□in□table□ 
1.□Information□in□table□2□should□include□CBC,□ESR,□chem.□panel,□O&P,□stool□occult□blood□and□flex□sig,□ 
with□subgroup□analyses□of□colon□imaging□(c-scope,□BE,□flex□sig)□for□persons□>50□at□time□of□diagnosis.□It□ 
is□not□clear□why□thyroid□testing□appears□in□table□2□since□it□is□not□listed□in□table□1.□ 
9.□A□format□similar□to□Table□2□(with□modification)□should□be□used□to□compare□testing□among□patients□ 
seen□only□by□FPs□versus□those□referred□on□for□GI□consultation.□ 
10.□table□2.□Is□information□regarding□IBS□symptom□complex□(e.g.,□predominant□diarrhea,□constipation,□ 
pain)□valid□and□reliable?□If□not□then□available□then□summary□data□for□small□bowel□radiograph,□lactose□ breath□test,□and□abdominal□XR□need□not□be□reported.□This□would□likely□underestimate□testing□performed, 
since□recommended□testing□is□dependent□on□predominant□symptoms.□Alternatively,□testing□among□these 
sub-groups□could□be□reported□in□a□separate□table□with□the□denominator□in□each□group□noted.□ 
11.□page□9,□3□lines□from□bottom□-□delete□"significantly"□ 
12.□page□10,□paragraph□2□-□was□an□economic□modeling□performed?□If□not□difference□in□(short-term)□ 
outcome□is□suggested□what□is□the□implication□of□LESS□testing?□(as□suggested□in□text□on□bottom□half□of□ page□11)□What□about□patient□perspective□regarding□need□for□testing?□ 
13.□bottom□page□12□-□reformatting□table□2□to□allow□clear□presentation□of□colon□imaging□data□for□persons□ 
ages□50+□may□provide□reader□with□further□relevant□information.□Comparison□to□BRFSS□data□on□ colorectal□cancer□screening□is□suggested□(Am□J□Prev□Med□2001;□21;□132-137).□ 
14.□page□13,□line□#6□-□is□it□valid□to□use□the□term□"primary□care□physicians"□without□further□information□on□ 
the□specialty□designations□(see□#6□&□7□above)□ 
Competing□interests: 
None□declared.