A NICE guideline, which was issued in February 2008, looks at the diagnosis and management of irritable bowel syndrome (IBS) in adults in primary care.
NICE recommends that healthcare professionals should consider assessment for IBS if the person reports having abdominal pain or discomfort, bloating, or change in bowel habit for at least six months. Anyone presenting with IBS symptoms should be asked about and assessed for red flag indicators (e.g. unintentional or unexplained weight loss, rectal bleeding, family history of bowel or ovarian cancer, late onset anaemia, abdominal masses) and if present, should be referred for further investigations. A diagnosis of IBS should be considered if the person has abdominal pain or discomfort that is relieved by defaecation or associated with altered bowel frequency or stool form and at least two of: altered stool passage; abdominal bloating, distension, tension or hardness; symptoms made worse by eating; or passage of mucous. Tests that should be undertaken to exclude diagnosis are also outlined in the guideline (e.g. full blood count, erythrocyte sedimentation rate (ESR) etc).
NICE stresses the importance of self-help measures in the management of IBS. People should be given information on general lifestyle (e.g. regular meals, plenty of fluids), diet (e.g. limited fruit and fibre intake, taking soluble fibre) and increasing physical activity. Medication should be targeted at the predominant symptoms (e.g. antispasmodics, laxatives for constipation, anti-motility agents for diarrhoea). Also people with IBS should be advised how to adjust doses according to the clinical response with the aim of achieving a soft, well-formed stool.
Action: Primary care clinicians who are involved in the diagnosis and management of people with IBS should be familiar with this guideline.