1. Presenting with IBS symptoms, baseline assessment.
IBS pathway 1:
Presenting with IBS symptoms, baseline assessment.
Bloating in women please consider
Ovarian Cancer screening – Nice CG122
Patient AGED <45 YO presenting with lower gastrointestinal symptoms for at least 6 months suggestive of irritable bowel syndrome (IBS) WITHOUT ALARM SYMPTOMS: • Abdominal pain (relieved by defecation, made worse by eating IBS-A) • Bloating (IBS-B) • Constipation (IBS-C) altered bowel frequency or stool form • Diarrhoea (IBS-D) is common; overlap exists (IBS-M– mixed)
FBC, U&E, LFT,CRP, Coeliac screen, TFTs, Stool MCS.
Constipation, should be refereed directly to the “IBS” treatment options – IBS pathway 2.
+Ve Coeliac Screen
Diarrheoa
Check Faecal Calprotectin (FCALP)
RED FLAGS – ANY ONE OF THE FOLLOWING
Age >45
Rectal/Abdominal Mass
Unintentional weight loss
Unexplained IDA
Persistent rectal bleeding/bloody diarrhoea that does not resolve.
Family history of bowel or ovarian cancer (affected relative <50 years)
> 60 years of age, a change in bowel habit lasting more than 6 weeks with looser and/more frequent stools
Raised CRP, and/or FCALP >150
Bloods normal and/or FCALP <60
Bloods normal and/or FCALP
Repeat FCALP in 4 weeks from first test;
Stop aspirin/NSAIDs
Primary care
IBS pathway
Referral to GI, Avoid dietary restrictions until endoscopy complete
2WW Referral GI/Colo-rectal
Refer for ‘new IBD’ clinic appt
Secondary care

2. IBS pathway 2:
Treatment options
This only applies to patients that IBD or other significant pathology has been excluded via IBS initial algorithm
Treatment for IBS can involve any of the following modalities
All treatment options are based on recommendations of NICE CG61 IBS 2015.
Medicine
Diet
Psychological intervention
Physical activity
High incidence of Anxiety, stress & depression
Refer to talking therapies IAPT on , or: by to:
First Line Diet & Lifestyle Advice
prior to dietetics referral
Key symptom
DIARRHOEA
CONSTIPATION
Second-Line options
Primary care:
Lubiprostone 24mcg
Secondary care
Pruculapride 2mg (RICAD)
Linaclotide 290mg (RICAD)
Trial antispasmodic
Eg Colpermin/Buscopan
Loperamide 2mg capsules 2-4 caps twice a day max 16 mg daily
First Line
Ispaghula OR Macrogol for 6/12
Consider any of the following as second line for pain symptoms
TCA
Eg Amitriptyline 10mg-30mg at night
SSRI
(if TCA ineffective)
Eg Fluoxetine 20mg once daily

3. Suggested Diet & Lifestyle advice
First Line Advice : to be given by primary care on diagnosis prior to pharmacological intervention.
- Regular meal pattern of 3 meals a day
- 5-a-day recommendation for fruit & vegetables
l fluid per day
- Wholegrain starchy carbohydrate choices eg wholemeal bread, wholegrain cereal, brown pasta, brown rice
- Reduce caffeine and alcohol intake
- Limit high fat foods
- Provide literature produced by British Dietetic Association
Summary guidelines