Irritable bowel syndrome (IBS)

There is helpful, patient-friendly information available in videos made by the NHS Lothian team:

Background:

Consider a POSITIVE diagnosis of IBS in patients with any of the following symptoms for >6 months:

Features such as bloating, lethargy, nausea, backache and bladder symptoms are common in people with IBS and may be used to support the diagnosis.

NOTES.

Family history of colon cancer is especially relevant if a first degree relative (FDR) <50yrs is affected, or if there are 2 FDRs affected at an older age.
Faecal calprotectin is useful in identifying patients with a higher probability of organic colonic disease.
In patients with persistent watery diarrhoea not responding to Rx, consider the possibility of microscopic colitis and possible need for colonic biopsies. Consider stopping PPI therapy.

Who to refer, who not to refer, how to refer

IBS Post-Diagnostic Management and Referral Pathway

General points

Suggestive clinical criteria
Absence of red flag symptoms
Negative screening tests for coeliac disease (serology) and IBD (faecal calprotectin)

Once a POSITIVE diagnosis has been made, treatment is consists of reassurance and symptom relief.
This requires a very good understanding of what the symptoms are so a good history is vital
Asking the patient to complete a symptom diary over 4 weeks is very helpful in clarifying the main symptoms
Different approaches to treatment work better for different individuals and it is often necessary to trial a number of different approaches before settling on one which is most effective.
A failure of one or two therapies is frustrating but common. It is not, in itself an indication that the primary diagnosis is wrong.

Outline of therapy

Selection of diet, drug or psychological interventions will be influenced by patient preference and local availability. Combination approaches may be appropriate for some patients.
Drug therapies “below the line” should currently be regarded as primarily for specialist initiation.

Management