{"doi":"10.1016/j.cgh.2023.04.030","title":"Potential Value of Biomarker-Based Approaches for Evaluation and Management of Costly Functional Gastrointestinal Diseases","abstract":"Functional gastrointestinal disorders including irritable bowel syndrome (IBS) are costly diseases associated with significant direct and indirect costs. This treatise deals predominantly with IBS, and we apply the same principles to another example, functional dyspepsia. Strategies to control direct expenditure in IBS were proposed over 2 decades ago1Camilleri M. Williams D.E. Economic burden of irritable bowel syndrome. Proposed strategies to control expenditures.Pharmacoeconomics. 2000; 17: 331-338Crossref PubMed Scopus (97) Google Scholar and include the education of physicians that manage patients with IBS, education of the patients themselves, introduction of psychological treatments, and addressing psychosocial issues early in the management process, curtailing unnecessary investigations, and developing effective doctor–patient relationships.2Drossman D.A. Chang L. Deutsch J.K. et al.A review of the evidence and recommendations on communication skills and the patient-provider relationship: a Rome Foundation working team report.Gastroenterology. 2021; 161: 1670-1688.e7Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar Since then, there has been significant documentation regarding the direct and indirect costs associated with IBS. A prior study evaluated the cost-effectiveness of tests for diarrhea-predominant IBS (IBS-D), but the biomarker tests pertained to investigations to exclude alternative diagnoses, rather than to focus on biomarkers related to the etiopathogenesis of the IBS.3Almario C.V. Noah B.D. Jusufagic A. et al.Cost effectiveness of biomarker tests for irritable bowel syndrome with diarrhea: a framework for payers.Clin Gastroenterol Hepatol. 2018; 16: 1434-1441.e21Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Since that report in 2018, there has been significant advance in the identification of biomarkers and potentially therapeutic reversal of the related mechanisms. The purpose of this review is to introduce the potential of biomarker-based approaches for the evaluation and management of IBS as an alternative to sequential therapeutic trials as proposed in recent guidelines. There are several lines of evidence that document the high cost associated with IBS. First, a study from the United Kingdom4Goodoory V.C. Ng C.E. Black C.J. et al.Direct healthcare costs of Rome IV or Rome III-defined irritable bowel syndrome in the United Kingdom.Aliment Pharmacol Ther. 2022; 56: 110-120Crossref PubMed Scopus (25) Google Scholar has documented direct healthcare costs of Rome IV– or Rome III–defined IBS. Thus, the mean annual direct cost of IBS per person among 752 patients with Rome IV IBS was £556.65 ± 1023.92, and for 995 patients with Rome III IBS, the mean annual direct cost was £474.16 ± 897.86. It was also estimated that the annual direct healthcare cost of IBS in the United Kingdom is £1.27 billion (Rome IV IBS) and £2.07 billion (Rome III IBS). In fact, among patients with Rome IV IBS, mean annual costs were higher in those with opiate use (£907.90 vs £470.58; P < .001), more severe symptoms (P < .001 for trend), shorter duration of IBS (1 year: £1227.14 vs >5 years: £501.60; P = .002), lower quality of life (P < .001 for trend), and higher depression, somatization, and gastrointestinal symptom-specific anxiety score. Second, also from the United Kingdom, symptom subgroups in individuals with IBS predicted disease impact and burden.5Black CJ, Ng CE, Goodoory VC, et al. Novel symptom subgroups in individuals with irritable bowel syndrome predict disease impact and burden. Clin Gastroenterol Hepatol. 2023 Feb 27 [E-pub ahead of print].Google Scholar In this analysis, 7 clusters of patients with IBS were identified based on the presence of diarrhea, constipation, gastrointestinal symptoms, and psychological burden. It was demonstrated that high psychological burden was associated with worse quality of life (both IBS specific and generic), as well as with reduced productivity, ","journal":"Clinical Gastroenterology and Hepatology","year":2023,"id":357177,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":14,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9592,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":670317,"name":"Joelle BouSaba","orcid":null,"position":1,"is_corresponding":false},{"id":94950,"name":"Michael Camilleri","orcid":"0000-0001-6472-7514","position":0,"is_corresponding":true}],"reference_count":87,"raw_metadata":null,"created_at":"2026-07-19T01:13:34.795336Z","pmid":"37164114","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}