Skip to main content

Main menu

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • Other Publications
    • abfm

User menu

Search

  • Advanced search
American Board of Family Medicine
  • Other Publications
    • abfm
American Board of Family Medicine

American Board of Family Medicine

Advanced Search

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • JABFM on Bluesky
  • JABFM On Facebook
  • JABFM On Twitter
  • JABFM On YouTube
LetterCorrespondence

Re: Irritable Bowel Syndrome: A “Mesh” of a Situation

Joseph M. Norris and David R. McGowan
The Journal of the American Board of Family Medicine May 2012, 25 (3) 398-399; DOI: https://doi.org/10.3122/jabfm.2012.03.120030
Joseph M. Norris
BSc (Hons)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
David R. McGowan
BSc (Hons)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • References
  • Info & Metrics
  • PDF
Loading

To the Editor:

We read with great interest Dr. Barnes'1 brief report and literature review in the January/February 2012 issue of the Journal of the American Board of Family Medicine. He describes a fascinating case in which the symptoms of irritable bowel syndrome (IBS) result from a rare mechanical cause: mesh herniorrhaphy. He demonstrates the value of meticulous history taking, examination, and investigation in patients with IBS, particularly if medical management proves ineffective. Dr. Barnes' case acts as a reminder of the challenges that diagnoses of IBS (and other diagnoses of exclusion) pose, and we believe it is pertinent to briefly elaborate on this.

Well-known examples of diagnoses of exclusion (per exclusionem) include IBS, “fever of unknown origin,” chronic fatigue syndrome, and fibromyalgia. Although these conditions have well-researched questionnaires and assessment tools (eg, for bowel dysfunction),2 there is a fundamental lack of understanding of both the underlying pathophysiology and the mechanism of action of their treatments. We do not imply that these conditions are without a pathologic process, nor do we suggest that they are fictitious or “psychological” (an anecdotal opinion of some physicians); rather, we believe that they represent heterogeneous clusters of unknown pathologic processes, grouped by symptoms. Forming these diagnoses occurs without objective verification, often after a crude process of elimination. In reality, we think this highlights an intrinsic desire of doctors to provide a diagnosis for patients. This diagnosis then acts as a basis on which to initiate treatment and provide, to the extent of the abilities of a modern physician, a form of reassurance to both doctor and patient. However, the use of a diagnosis of exclusion unfortunately can be tantamount to saying that a true diagnosis is not known. Herein lies the problem with modern medicine—we can image the functioning brain and examine the deepest recesses of the human body, but we remain uncomfortable uttering 3 words: “I don't know.”

To progress as a profession, we need to understand that a diagnosis of exclusion should be seen as a target for research. Individual pathologic processes must be elucidated carefully if we are to understand the myriad conditions that contribute to the aforementioned umbrella terms. Sunderji et al3 utilized electrocardiography in an attempt to elevate tako-tsubo cardiomyopathy from a diagnosis of exclusion. Ultimately, they failed, further highlighting the difficulty of these diagnoses. We must not be discouraged, but rather, continue the quest to find the best methods of discerning the constituent parts of these diagnoses. After identifying these problems we will be in a position to generate diagnoses of inclusion rather than exclusion. We will then be better able to diagnose and treat our patients, which, ultimately, is the raison d'être of a doctor.

Notes

  • The above letter was referred to the author of the article in question, who offers the following reply.

References

  1. 1.↵
    1. Barnes MG
    . Irritable bowel syndrome: a “mesh” of a situation. J Am Board Fam Med 2012;25(1):120–3.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Leung L,
    2. Riutta T,
    3. Kotecha J,
    4. Rosser W
    . Chronic constipation: an evidence-based review. J Am Board Fam Med 2011;24(4):436–51.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Sunderji S,
    2. Ariyarajah V,
    3. Solodum V,
    4. Shaikh N,
    5. Tam JW
    . Electrocardiographic criteria in tako-tsubo cardiomyopathy-is there added certainty in a diagnosis per exclusionem? Am Heart Hosp J 2009;7(2):130–5.
    OpenUrl
PreviousNext
Back to top

In this issue

The Journal of the American Board of Family     Medicine: 25 (3)
The Journal of the American Board of Family Medicine
Vol. 25, Issue 3
May-June 2012
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Re: Irritable Bowel Syndrome: A “Mesh” of a Situation
(Your Name) has sent you a message from American Board of Family Medicine
(Your Name) thought you would like to see the American Board of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
4 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Re: Irritable Bowel Syndrome: A “Mesh” of a Situation
Joseph M. Norris, David R. McGowan
The Journal of the American Board of Family Medicine May 2012, 25 (3) 398-399; DOI: 10.3122/jabfm.2012.03.120030

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Re: Irritable Bowel Syndrome: A “Mesh” of a Situation
Joseph M. Norris, David R. McGowan
The Journal of the American Board of Family Medicine May 2012, 25 (3) 398-399; DOI: 10.3122/jabfm.2012.03.120030
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • To the Editor:
    • Notes
    • References
  • References
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Hepatitis C Treatment Knowledge, Attitudes, and Practices Among Primary Care Providers—Los Angeles County, 2023
  • Re: Factors Influencing Patient Confidence in Screening Mammography
  • Re: Physician and Advanced Practice Clinician Burnout in Rural and Urban Settings
Show more Correspondence

Similar Articles

Navigate

  • Home
  • Current Issue
  • Past Issues

Authors & Reviewers

  • Info For Authors
  • Info For Reviewers
  • Submit A Manuscript/Review

Other Services

  • Get Email Alerts
  • Classifieds
  • Reprints and Permissions

Other Resources

  • Forms
  • Contact Us
  • ABFM News

© 2025 American Board of Family Medicine

Powered by HighWire