Update information March 2017 Recommendation 1.1.1.2 in the short version was updated by NICE with more recent guidance on recognition and referral for suspected cancer. Recommendation 1.1.1.3 in the short version was removed as it was no longer needed after the changes to recommendation 1.1.1.2. February 2015 NICE has made new recommendations relating to the clinical management (dietary and lifestyle advice, and pharmacological therapy) of people with IBS. The recommendations and evidence in sections 3, 7.6, 8.4, 8.5.2 and 9.1 of this guideline that have been highlighted in grey have been stood down and replaced. New recommendations on dietary and lifestyle advice, and pharmacological therapy, can be found in the irritable bowel syndrome in adults update CG61.1. September 2012 A recommendation in this guideline (see pages 28 and 37) has been partially updated by recommendation 1.1.2.1 in 'Ovarian cancer' (NICE clinical guideline 122, 2011).
The aims of the guideline are:
- To evaluate and summarise the clinical and cost evidence relating to all aspects of the diagnosis and treatment of Irritable Bowel Syndrome (IBS).
- To highlight gaps in the research evidence.
- To formulate evidence-based cost effective clinical practice recommendations relating to the diagnosis and treatment of IBS.
- To formulate consensus recommendations shaped around available evidence and expert GDG opinion in those areas of diagnosis and treatment of IBS where there is no clear clinical and cost effective evidence base.
4.1. Who the guideline is for
The guideline is of relevance to all people with IBS, carers for those people with IBS, primary healthcare professionals and social care staff that are involved in the care and/or support of those people diagnosed with IBS.
4.2. Groups covered by the guideline
Adults (18 years and older) who present to primary care with symptoms suggestive of IBS are covered by the guideline.
4.3. Groups not covered by the guideline
The following groups are not covered by the guideline:
- Patients with other gastrointestinal disorders such as non-ulcer dyspepsia or coeliac disease will not be covered, except when a co-morbidity has specific relevance to the management of IBS.
- Children and young people under 18 years of age.
4.4. Healthcare setting
It is recognised that the NHS is rapidly developing patterns of service delivery, with primary and secondary care borders blurring. The guideline will cover the care that is provided by primary healthcare professionals and it will indicate where secondary care referral is appropriate. The guideline is sensitive to the variations in commissioning of services relating to the diagnosis and treatment of IBS. The guideline recognises that there is current variation to service availability in both primary and secondary care across England and Wales, and at times will not state where care is accessed.
4.5. Diagnosis and management interventions covered by the guideline
The following diagnostic and treatment interventions will be covered. They have been classified into logical coherent areas of the guideline, supported by clinical and cost effectiveness reviews, and are consistent with the patient algorithm which typically reflects the patient pathway.
Diagnosis
Positive Diagnosis utilises criterion based reference tools. Negative diagnosis uses exclusion diagnosis through negative test results. This is typically characterised by primary care clinicians requesting a raft of investigations to rule out other co-morbidities. Diagnosis also addresses the identification of red flags that may lead to an alternative diagnosis such as bowel cancer. This guideline is cross referenced to NICE clinical guideline 27 (Suspected Cancer Referral).
Lifestyle: diet and exercise
This section of the guideline reviews clinical and cost effectiveness evidence relating to patient lifestyle. It is focussed on shared care decision making between the primary care clinician and the person with IBS. This develops coping behaviours and modifies lifestyle relating to dietary input/changes and levels of exercise that work towards alleviating symptom based IBS profiles.
Drug therapy
This section of the guideline reviews clinical and cost effectiveness evidence relating to different pharmacological treatments options that are prescribed to alleviate symptom based IBS profiles.
Referral and follow-up
This section provides consensus based recommendations and narrative on the importance of referral and follow up once diagnosis has been made. This also incorporates clinical and cost effective reviews and recommendations on referral for people with intractable IBS, defined as a continuing symptom profile and lack of response to first line treatment interventions.
4.6. Interventions not covered by the guideline
If during the process of diagnosis for IBS another disease is suspected, further diagnosis and treatment of this disease will not be covered. Management and diagnosis of co-morbidity will not be covered. New drugs in development are not covered as they are not licensed for use.
4.7. Guideline Development Group
The guideline recommendations were developed by a Guideline Development Group (GDG) convened by the NICE-funded National Collaborating Centre for Nursing and Supportive Care (NCC-NSC) with membership approved by NICE. Members included representatives from patient groups; nursing; general practice and gastroenterology medicine; pharmacy; dietetics; public health; technical team from the NCC-NSC.
The GDG met 13 times between May 2006 and July 2007. All members of the GDG were required to make formal declarations of interest at the outset, and these were updated at every subsequent meeting throughout the development process. This information is recorded in the meeting minutes and kept on file at the NCC-NSC. The GDG declarations are recorded in Appendix K.
Publication Details
Copyright
Publisher
Royal College of Nursing (UK), London
NLM Citation
National Collaborating Centre for Nursing and Supportive Care (UK). Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care [Internet]. London: Royal College of Nursing (UK); 2008 Feb. (NICE Clinical Guidelines, No. 61.) 4, Aims of the guideline.