Faecal biomarker patterns in patients with symptoms of irritable bowel syndrome.

OBJECTIVE: To determine rates of faecal biomarker results capable of suggesting potentially treatable causes of irritable bowel syndrome (IBS) symptomatology in a population of patients with symptoms of IBS who meet Rome III criteria for that condition. DESIGN: Descriptive, retrospective study in which faecal biomarker results (dichotomised into 'normal' and 'abnormal' values) were related to data from patient-completed questionnaire data identifying demographics, Rome III criteria for IBS and IBS phenotype (IBS-D, IBS-C, IBS-M and IBS-U). SETTING: Commercial reference laboratory. PATIENTS: Individuals whose physicians ordered faecal biomarker testing for evaluation of chronic abdominal symptoms consistent with IBS. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Rates of occurrence of abnormal results on any of seven faecal biomarkers suggesting a treatable cause for IBS symptoms. RESULTS: Abdominal symptoms meeting Rome III criteria for IBS were present in 3553 records (the population), which were subjected to further analysis. Abnormal biomarker results (the outcomes) occurred in 94% of cases; 73% and 65% of records indicated growth of a bacterial potential pathogen and low growth of beneficial organisms, respectively. Abnormal results for all other faecal biomarkers occurred with frequencies from 5% to 13%. Frequency of abnormal results for elastase, calprotectin, eosinophil protein X, and beneficial organisms rose significantly with age, and differed significantly across IBS phenotypes. CONCLUSIONS: A large proportion of patients manifesting symptoms meeting Rome III IBS diagnostic criteria have faecal biomarker results indicating potential underlying, treatable causes of their symptoms. Faecal biomarker testing is an appropriate means of identifying potentially treatable causes of IBS symptoms.

Frequency of abnormal fecal biomarkers in irritable bowel syndrome.

PRIMARY STUDY OBJECTIVE: Determine the frequency of abnormal fecal biomarker test results in patients with 13 irritable bowel syndrome (IBS)-related ICD-9 (International Statistical Classification of Diseases and Related Health Problems) codes. STUDY DESIGN: Quantitative review of de-identified records from patients in whom IBS was a possible diagnosis. METHODS: Records were selected for analysis if they included any of 13 IBS-related diagnostic codes and laboratory test results of fecal testing for all biomarkers of interest. Data collection was restricted to one 12-month period. Frequency distributions were calculated to identify rates of abnormal results for each biomarker within the total number of tests conducted in the eligible population. RESULTS: Two thousand, two hundred fifty-six records were included in the study, of which 1867 (82.8%) included at least one abnormal value. Quantitative stool culture for beneficial bacteria (Lactobacillus and Bifidobacterium) indicated low growth suggestive of intestinal dysbiosis in 73.1% of records, followed by abnormally elevated eosinophil protein X (suggestive of food allergy) in 14.3%, elevated calprotectin (suggestive of inflammation) in 12.1%, detection of parasites in 7.5%, and low pancreatic elastase (suggestive of exocrine pancreatic insufficiency) in 7.1%. CONCLUSIONS: Abnormal fecal biomarkers are prevalent in patients with diagnoses suggestive of IBS. Abnormal fecal biomarker testing, if confirmed in additional independent clinical trials, could substantially reduce the economic costs associated with diagnosis and management of IBS.

Novel Testing Enhances Irritable Bowel Syndrome Medical Management: The IMMINENT Study.

PRIMARY STUDY OBJECTIVE: To evaluate the economic utility of a fecal biomarker panel structured to suggest alternative, treatable diagnoses in patients with symptoms of irritable bowel syndrome (IBS) by quantifying, comparing, and contrasting health service costs between tested and non-tested patients. STUDY DESIGN: Retrospective, matched cohort study comparing direct medical costs for IBS patients undergoing fecal biomarker testing with those of matched control subjects. METHODS: We examined de-identified medical and pharmacy claims of a large American pharmacy benefit manager to identify plan members who underwent panel testing, were eligible for covered benefits for at least 180 days prior to the test date, and had data available for 30, 90, and 365 days after that date. We used propensity score matching to develop population-based control cohorts for each tested cohort, comprised of records with IBS-related diagnoses but for which panel testing was not performed. Primary outcome measures were diagnostic and medical services costs as determined from claims data. RESULTS: Two hundred nine records from tested subjects met inclusion criteria. The only significant baseline differences between groups were laboratory costs, which were significantly higher in each tested cohort. At each follow-up time point, total medical and gastrointestinal procedural costs were significantly higher in non-tested cohorts. Within tested cohorts, costs declined significantly from baseline, while costs rose significantly in non-tested control cohorts; these differences were also significant between groups at each time point. CONCLUSIONS: Structured fecal biomarker panel testing was associated with significantly lower medical and gastrointestinal procedural costs in this study of patients with IBS symptoms.

Examining healthcare disparities in a disease management population.

OBJECTIVES: To examine whether racial disparities in healthcare exist in a heart failure population and to estimate the impact of disease management (DM) on any identified disparities. STUDY DESIGN: Before-after cohort study. PATIENTS AND METHODS: A total of 2619 high-risk heart failure patients (2129 whites and 490 blacks) who participated in a DM program for at least 90 days between July 2001 and July 2003 were examined. Analysis was stratified by sex and age (< 65 years and > or = 65 years). Functional status as measured by the New York Heart Association (NYHA) classification system and mental and physical quality of life (QOL) as measured by the 8-Item Short-Form Health Survey were used to assess disparities between races. RESULTS: At baseline, 33.7% of black versus 44.3% of white older women and 32.6% of black versus 48.5% of white older men were at NYHA level I or II (P < .01 and P = .005, respectively). At the most current measurement, the differences between the cohorts disappeared. Results were similar for the younger male, but not the younger female, cohort. The only QOL disparities at baseline were in favor of blacks. Both races had significant increases in mean mental and physical QOL scores (P < .001) after involvement in the DM program. CONCLUSIONS: Disparities in QOL were not observed between blacks and whites at baseline or over the course of the study. Disparities in functional status at baseline disappeared over time, implying that DM may help reduce disparities and maintain equity in healthcare outcomes.

Disease management positively affects patient quality of life.

Health care costs are spiraling upward. The population of the United States is aging, and many baby boomers will develop multiple chronic health conditions. Disease management is one method for reducing costs associated with chronic health conditions. Although these programs have been proven effective in improving patient health, detailed information about their effect on patient quality of life has been scarce. This article provides preliminary evidence that disease management programs for coronary artery disease, chronic obstructive pulmonary disease, diabetes, and heart failure lead to improved quality of life, which correlates with a healthier, more satisfied, and less costly patient.