Reviewed on : 6 Oct 2017

Reviewed by : Dr Ben Disney, UHCW

Expires : 6 Oct 2019

Irritable bowel syndrome – please click for the IBS pre-referral investigations flow chart.

Patients <45 years of age with symptoms of IBS for 3 months and no red flag symptoms.  These guidelines also apply to patients with chronic diarrhoea.

Anyone above 45 years or with red flags should be referred regardless.

Pre-referral investigations:

1 Blood tests – FBC, TSH, CRP, calcium, coeliac serology
2 Stool sample –
a. faecal calprotectin
i. <50 – likely to be IBS.
ii. 50-250 – intermediate. Repeat sample after 4-6 weeks. If still raised refer to Gastroenterology.
iii. >200 – consistent with bowel inflammation. Refer to Gastroenterology.
b. stool culture and clostridium difficile toxin

Treatment:

1. Dietary advice – follow BDA IBS Food facts advice.
2. Target the symptom e.g. peppermint, antispasmodics, laxatives, anti-diarrhoeal medication.

Referral threshold:
Refer if the diagnosis is in doubt or if usual management has failed.