Irritable bowel syndrome (IBS) is one of those conditions that can be surprisingly difficult to manage in primary care. Symptoms vary from patient to patient, there is no single diagnostic test, and the line between investigating enough and investigating too much is not always straightforward.
It is also incredibly common. IBS affects an estimated 10 to 20 percent of the population and is a chronic, relapsing condition that can have a significant impact on quality of life. For the NHS, the financial burden is substantial, with IBS estimated to cost between £1.3 and £2.0 billion each year.
For clinicians, getting the diagnosis right is an important first step. A positive diagnosis can be made based on symptoms rather than exhaustive investigations, while remaining alert to red flags that may warrant further investigation or referral.
Four Priorities for Your Next IBS Consultation
Managing IBS effectively starts with understanding the individual patient’s presentation rather than taking a one-size-fits-all approach.
- Recognise the pattern: Consider IBS in patients with persistent abdominal pain or discomfort, bloating or changes in bowel habit, while paying close attention to the relationship between pain, defaecation and stool frequency or form.
- Investigate selectively: Appropriate blood and stool tests can help exclude other diagnoses, including coeliac disease, infections and inflammatory bowel disease. Further hospital investigations are not usually needed unless there is uncertainty around the diagnosis.
- Look for red flags: Before settling on an IBS diagnosis, assess for features that could indicate another condition and warrant further investigation or referral.
- Consider the symptom profile: IBS can present differently from patient to patient, with diarrhoea, constipation, abdominal pain and bloating among its main symptoms. Understanding which symptoms are having the greatest impact can help guide the conversation around management
For patients whose symptoms persist despite general dietary and lifestyle measures, further dietary management, including approaches such as a low-FODMAP diet, may be considered with support from a healthcare professional with expertise in dietary management.
Strengthen Your Approach to IBS
Want a practical refresher on diagnosing and managing IBS in primary care?
Our 30-minute RCP-accredited eCPD course, Optimising Outcomes in People with Irritable Bowel Syndrome, is designed specifically for UK healthcare professionals.
Through the course, you will learn how to:
- Recognise alarm symptoms that could point to a diagnosis other than IBS.
- Identifier which investigations are useful and which may be unnecessary.
- Select appropriate pharmacological and non-pharmacological treatments according to IBS subtype.
- Understand the wider burden of IBS on patients and the healthcare system.