“IBS” GO TIMEE™️
Method for Diagnosis & Management of “IBS” (Irritable Bowel Syndrome)
by
primary care specialists rather than gastroenterologists

 Patients with “IBS” aren’t receiving good care. Here’s why …

“IBS”

“IBS” (with quotation marks) is a triad of symptoms called enteropathy (ICD-10 diagnostic code is K63.9) implicating the small intestine, colon, and/or rectum as the source (ie, the gut):

  • abdominal pain and/or discomfort,

  • gas – abdominal bloating, distention or enlargement, flatulence, and noisy intestinal sounds, and

  • bowel dysfunction – constipation, diarrhea, or both.

Research confirms at least 45 million Americans suffer with this “IBS” enteropathy symptom triad; it’s also a worldwide problem affecting up to 11% of the population. “IBS” comprises 12 percent of patients in a primary care practice. Diagnosis of “IBS” requires absence of concerning features or “red flags” (e.g., blood in the stool, unintentional weight loss, nocturnal diarrhea, new onset of progressively worsening symptoms, abnormal physical examination, and/or abnormal laboratory tests, including anemia).

IBS (the DGBI)

Gastroenterologists consider IBS (K58 diagnostic codes) to be the most common of several Disorders of Gut-Brain Interaction (DGBI) formerly called functional GI (gastrointestinal) disorders) or FGID. IBS is the seventh most common diagnosis made in primary care. There’s a second “brain-in-the-gut,” and both brains intercommunicate 24/7, largely at the subconscious level. Most of the information is “bottoms up” from gut to brain. Symptoms are generated related to disturbances involving motility (contraction) dysfunction, heightened sensation, barrier dysfunction (leaky gut), chronic immune-mediated inflammation, and gut microbiome dysbiosis.

Stress and emotional distress operate bidirectionally, predominantly at the subconscious level. GI symptoms can cause stress and emotional distress; reciprocally, stress and emotional distress can exacerbate and cause GI symptoms.

THE PROBLEM:
Inaccurate and inefficient diagnosis of “IBS” Enteropathy
as IBS results in ineffective and unnecessarily costly
treatment and management.

Along with the diagnosis of IBS (the DGBI), there are six common underlying disorders and diseases masquerading as, or associated with, IBS that usually aren’t being recognized and diagnosed. We call them the “Pick Six” to use a football analogy. Many have more than one of the Pick Six.

  • For example, the most common of the Pick Six is gut microbiome dysbiosis (e.g., SIBO or small intestinal bacterial overgrowth) that can be diagnosed with a new breath test developed by gastroenterologist Mark Pimentel, MD called trio-smart®️.

  • Another example is failure to accurately diagnose causes of chronic constipation, urgency, and feeling of incomplete evacuation, which can now be done with the RED (Rectal Expulsion Device).

IBS (the DGBI) and the Pick Six (seven diagnoses)
are ALL treatment targets, and
opportunities for improved clinical and economic outcomes
are lost without accurate and timely diagnosis.

IBS GO TIMEE™️

(Based upon the book, You’re on FIRE: Heal IBS, SIBO, Microbiome Dysbiosis & Leaky Gut to discover Whole Health

The method teaches primary care specialists to:

  • recognize the “IBS” enteropathy clinical triad (and other commonly associated symptoms, e.g., epigastric pain/dyspepsia) facilitated by a patient completed electronic data capture (EDC) intake form based upon the Patient Reported Outcomes Measurement Information System—Gastro-Intestinal Symptom Scales (PROMIS-GI),

  • diagnose “IBS” enteropathy (K63.9) initially rather than IBS (K58)*,

  • deploy validated blood, stool, breath, and RED testing, and then

  • apply treatment directed to the seven possible diagnoses (IBS-DGBI and the Pick Six).

(* It may be necessary to apply an IBS diagnostic code initially for testing reimbursement purposes.)

Teaching the method is facilitated through use of TalentCards.com, a mobile training program that exploits “microlearning” and spaced repetition.

In the absence of “red flags”, referral to gastroenterologists usually isn’t necessary. Colonoscopies and scans can (and should) be avoided because they don’t show these underlying disorders and diseases, are expensive, involve risk, and in the case of CT scans, unnecessary radiation exposure.

I’m collaborating with Applied Healthcare Research Management (AHRM) Inc, a Global CRO (Contract Research Organization) with a focus in Health Economics and Outcomes Research founded by Raf Magar. Together we’ll conduct real world research to confirm both better clinical outcomes while substantially reducing healthcare costs. Continuous quality improvement will be based upon this research.

We have begun discussions with Mount Carmel Medical Group primary care specialists, (a member of Trinity Health)
to conduct the pilot program for “IBS” GO TIMEE™️.
info@WilliamSaltMD.com or
rmagar@ahrminc.com