(Note: on this post the grey text denotes material taken from the NICE website as downloaded on 04/01/15)

The Rome III Criteria for the diagnosis of IBS are more precisely defined and given as; At least 3 months, with onset at least 6 months previously of recurrent abdominal pain or discomfort associated with 2 or more of the following:

 

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Red Flags in IBS

Ask all people with possible irritable bowel syndrome symptoms if they have any of the following ‘red flag’ indicators and refer them to secondary care for further investigation if they have.

• Unintentional and unexplained weight loss.
• Rectal bleeding.
• A family history of bowel or ovarian cancer.
• In people aged over 60, a change in bowel habit lasting more than 6 weekswith looser and/or more frequent stools.

Assess and clinically examine all people with possible irritable bowel syndrome symptoms and refer to secondary care if any of the following ‘red flags’ are found:

• anaemia
• abdominal masses
• rectal masses
• inflammatory markers for inflammatory bowel disease.

Measure serum CA125 in primary care in women with symptoms that suggest ovarian cancer in line with NICE’s pathway on ovarian cancer.

See the NICE pathway on suspected cancer recognition and referral for detailed referral criteria where cancer is suspected.

NICE has also produced a pathway on colorectal cancer.

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Assessing the Impact of IBS

Several tools have been proposed, used and validated for use in assessing the impact or quality of life of IBS on patients.

A thorough comparison of the various tools is available on the website of one of the authors – Dr Drossman and a downloaded version (04/01/15) is mirrored here IBS-QOL published. The preferred tool that Cloud Health uses is the IBS-QOL which consists of 34 questions on a 0-5 Liekhert scale that considers 8 Dimensions (Dysphoria, Interference with activity, Body image, Health worry, Food avoidance, Social reaction, Sexual & Relationship).

The IBS-QOL is a proprietary questionnaire that is available from the University of Washington and was described for academic purposes in the American Journal of Gastroenterology on the website of the journal Nature and a downloaded version (04/01/15) of that is mirrored here. American Journal of Gastroenterology

http://www.nature.com/ajg/journal/v95/n4/fig_tab/ajg2000256t4.html

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Confirming a diagnosis of IBS in people who meet the diagnostic criteria

Faecal calprotectin testing

The following recommendations are from NICE diagnostics guidance on faecal calprotectin diagnostic tests for inflammatory diseases of the bowel.

Faecal calprotectin testing is recommended as an option to support clinicians with the differential diagnosis of inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS) in adults with recent onset lower gastrointestinal symptoms for whom specialist assessment is being considered, if:

• cancer is not suspected, having considered the risk factors (for example, age) described in the NICE pathway on suspected cancer recognition and referral, and
• appropriate quality assurance processes and locally agreed care pathways are in place for the testing.

Faecal calprotectin testing is recommended as an option to support clinicians with the differential diagnosis of IBD or non-IBD (including IBS) in children with suspected IBD who have been referred for specialist assessment, if:

• appropriate quality assurance processes and locally agreed care pathways are in place for the testing.

Other tests

Also, carry out the following tests to exclude other diagnoses:

• FBC
• ESR or plasma viscosity
• CRP
• serological testing for coeliac disease (see the NICE pathway on coeliac disease).

But do not do the following tests to confirm diagnosis of irritable bowel syndrome:

• ultrasound
• rigid/flexible sigmoidoscopy
• colonoscopy; barium enema
• thyroid function test
• faecal ova and parasite test
• faecal occult blood
• hydrogen breath test (for lactose intolerance and bacterial overgrowth).

Resources

The following implementation tool is relevant to this part of the pathway.

Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel: costing template

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