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Irritable Bowel Syndrome

 

Consider IBS in those with more than 6 months of:

  • Abdominal pain (may be relieved by defecation)
  • Bloating
  • Change in bowel habit (alteration in stool form or frequency)

In the majority of cases IBS can be confidently diagnosed and treated in primary care

 

Indications for referral

  • Please refer any atypical or alarm features (see below)
  • Symptoms not responding to primary care treatment

 

Primary care management/Investigations prior to referral

  • Reassurance and explanation
  • Dietary advice – beware excess insoluble fibre
  • Pain – buscopan / colpermin / amitriptyline / SSRI
  • Diarrhoea – loperamide
  • Constipation – fybogel / movicol
  • Bloating – probiotics
  • Psychological therapies if psychological symptoms predominate

 

  • Tests:
    • FBC CRP coeliac screen
    • Ca125 in women presenting with IBS symptoms especially if age 50 or over
    • Consider IBS in those with more than 6 months of:

 

Red flags

 

Clinics available

  • Lower GI Medical OP
  • Referrals will be rejected if primary care management is incomplete

 

Reference/Further Reading

https://www.nice.org.uk/guidance/cg61

http://patient.info/doctor/irritable-bowel-syndrome-pro