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.
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
- Dietary advice – follow BDA IBS Food facts advice.
- Target the symptom e.g. peppermint, antispasmodics, laxatives, anti-diarrhoeal medication.
Refer if the diagnosis is in doubt or if usual management has failed.