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Irritable bowel syndrome in adults overview

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Irritable bowel syndrome in adults HAI

About

What is covered

This pathway covers the diagnosis and management of irritable bowel syndrome in adults (18 years and older) in primary care.
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, with a prevalence estimated at between 10% and 20%. People present to primary care with a wide range of symptoms, some of which overlap with other gastrointestinal disorders.
Key elements of management are:
  • establishing a positive diagnosis
  • identifying symptoms that require prompt referral and
  • working in a long-term partnership with the person with irritable bowel syndrome.

Updates

Updates to this pathway

22 June 2015 Minor maintenance update.
25 February 2015 Inflammatory bowel disease (NICE quality standard 81) added to this pathway.
24 February 2015 New and amended recommendations on the clinical management (dietary and lifestyle advice, and pharmacological therapy) of people with IBS have been added to further dietary management and second-line pharmacological treatment in this pathway as the NICE guideline on irritable bowel syndrome in adults has been updated (CG61).
21 October 2014 Minor maintenance update.
12 May 2014 Minor maintenance update.
17 December 2013 Minor maintenance update.
1 October 2013 Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel (NICE diagnostics guidance 11) added in confirming a diagnosis of irritable bowel syndrome in people who meet the diagnostic criteria and SeHCAT (tauroselcholic [75 selenium] acid) for the investigation of diarrhoea due to bile acid malabsorption in people with diarrhoea-predominant irritable bowel syndrome (IBS-D) or Crohn's disease without ileal resection (NICE diagnostics guidance 7) added to related guidance.
11 June 2013 Minor maintenance update.
19 October 2012 Minor maintenance update.

Important information about diagnosing irritable bowel syndrome

Confirming a diagnosis of irritable bowel syndrome is crucial. The primary aim should be to establish the person's symptom profile, with abdominal pain or discomfort being a key symptom. It is also necessary to establish the quantity and quality of the pain or discomfort, and to identify its site (which can be anywhere in the abdomen) and whether this varies. This distinguishes irritable bowel syndrome from cancer-related pain, which typically has a fixed site.
When establishing bowel habit, showing people the Bristol stool form scale may help them with description, particularly when determining quality and quantity of stool. People presenting with irritable bowel syndrome symptoms commonly report incomplete evacuation/rectal hypersensitivity, as well as urgency, which is increased in diarrhoea-predominant irritable bowel syndrome. About 20% of people experiencing faecal incontinence disclose their incontinence only if asked. People who present with symptoms of irritable bowel syndrome should be asked open questions to establish the presence of such symptoms (for example, 'tell me about how your symptoms affect aspects of your daily life, such as leaving the house'). Healthcare professionals should be sensitive to the cultural, ethnic and communication needs of people for whom English is not a first language or who may have cognitive and/or behavioural problems or disabilities. These factors should be taken into consideration to facilitate effective consultation.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Short Text

Diagnosis and management of irritable bowel syndrome in primary care

What is covered

This pathway covers the diagnosis and management of irritable bowel syndrome in adults (18 years and older) in primary care.
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, with a prevalence estimated at between 10% and 20%. People present to primary care with a wide range of symptoms, some of which overlap with other gastrointestinal disorders.
Key elements of management are:
  • establishing a positive diagnosis
  • identifying symptoms that require prompt referral and
  • working in a long-term partnership with the person with irritable bowel syndrome.

Updates

Updates to this pathway

22 June 2015 Minor maintenance update.
25 February 2015 Inflammatory bowel disease (NICE quality standard 81) added to this pathway.
24 February 2015 New and amended recommendations on the clinical management (dietary and lifestyle advice, and pharmacological therapy) of people with IBS have been added to further dietary management and second-line pharmacological treatment in this pathway as the NICE guideline on irritable bowel syndrome in adults has been updated (CG61).
21 October 2014 Minor maintenance update.
12 May 2014 Minor maintenance update.
17 December 2013 Minor maintenance update.
1 October 2013 Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel (NICE diagnostics guidance 11) added in confirming a diagnosis of irritable bowel syndrome in people who meet the diagnostic criteria and SeHCAT (tauroselcholic [75 selenium] acid) for the investigation of diarrhoea due to bile acid malabsorption in people with diarrhoea-predominant irritable bowel syndrome (IBS-D) or Crohn's disease without ileal resection (NICE diagnostics guidance 7) added to related guidance.
11 June 2013 Minor maintenance update.
19 October 2012 Minor maintenance update.

Sources

NICE guidance

The NICE guidance that was used to create the pathway.
Irritable bowel syndrome in adults (2008 updated 2015) NICE guideline CG61

Quality standards

Inflammatory bowel disease

These quality statements are taken from the inflammatory bowel disease quality standard. The quality standard defines clinical best practice for inflammatory bowel disease care and should be read in full.

Quality statements

Specialist assessment

This quality statement is taken from the inflammatory bowel disease quality standard. The quality standard defines clinical best practice in inflammatory bowel disease care and should be read in full.

Quality statement

People with suspected inflammatory bowel disease have a specialist assessment within 4 weeks of referral.

Rationale

A confirmed diagnosis of inflammatory bowel disease is always made in an age appropriate specialist setting using a combination of haematological, endoscopic, histological and imaging based investigations. A delay in assessment and diagnosis can be associated with adverse consequences, such as clinical complications and a negative effect on the person’s quality of life. Some people with suspected inflammatory bowel disease who have severe symptoms will need an urgent specialist assessment, the urgency of which will depend on clinical need and might include an emergency admission, but no one should wait more than 4 weeks from referral for a specialist assessment.

Quality measures

Structure
Evidence of local referral pathways to ensure that people with suspected inflammatory bowel disease have a specialist assessment within 4 weeks of referral.
Data source: Local data collection. Data on referral pathways for urgent referrals are available in the National audit of inflammatory bowel disease (IBD) service provision, question OC1.2, and the National audit of paediatric inflammatory bowel disease (IBD) service provision, question OC2.1.
Process
Proportion of people with suspected inflammatory bowel disease who have a specialist assessment within 4 weeks of referral.
Numerator – the number in the denominator who have a specialist assessment within 4 weeks of referral.
Denominator – the number of people with suspected inflammatory bowel disease who are referred for specialist assessment.
Data source: Local data collection. Data on the time it takes for urgent referrals to be seen are available in the National audit of inflammatory bowel disease (IBD) service provision, question OC1.3, and the National audit of paediatric inflammatory bowel disease (IBD) service provision, questions OC2.4 and 2.6.
Outcome
Patient experience of the referral process.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (district general hospitals) ensure that local referral pathways are in place so that people with suspected inflammatory bowel disease are referred quickly and efficiently, and have a specialist assessment within 4 weeks of referral.
Healthcare professionals ensure that they follow agreed local referral pathways so that people with suspected inflammatory bowel disease are referred quickly and efficiently, and have a specialist assessment within 4 weeks of referral.
Commissioners (clinical commissioning groups and NHS England) ensure that they commission services that make use of agreed local referral pathways so that people with suspected inflammatory bowel disease are referred quickly and efficiently, and have a specialist assessment within 4 weeks of referral. This can be achieved through enhanced monitoring of contracts and establishing regular and timely auditing procedures.

What the quality statement means for patients, service users and carers

People with suspected inflammatory bowel disease are seen by a specialist in hospital for an assessment within 4 weeks of being referred by their GP. This means that a diagnosis can be made without delay and treatment options can be discussed. The specialist assessment might involve having blood tests or endoscopy (using a camera to provide images of the inside of the body). Inflammatory bowel disease includes Crohn’s disease and ulcerative colitis. Sometimes it is not possible to tell whether a person has Crohn’s disease or ulcerative colitis, and they may be described as having ‘inflammatory bowel disease unclassified’ (IBDU).

Source guidance

Definitions of terms used in this quality statement

Suspected inflammatory bowel disease
People with any of the following lower gastrointestinal symptoms that have been present for at least 6 weeks should be suspected of having inflammatory bowel disease:
  • abdominal pain or discomfort
  • bloating
  • change in bowel habit (such as diarrhoea with or without rectal bleeding).
Faecal biomarkers, such as faecal calprotectin, alongside clinical assessment may be useful in primary care to distinguish between suspected inflammatory bowel disease and non inflammatory bowel disease, such as irritable bowel syndrome. [Adapted from Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel NICE diagnostics guidance 11, section 3.1, and IBD Standards, standard A4]. The Quality Standard Advisory Committee noted that, in some people with severe symptoms, inflammatory bowel disease might be suspected before the symptoms have been present for 6 weeks, and these people need earlier referral (before 6 weeks).
Specialist assessment
People with suspected inflammatory bowel disease should be referred for specialist assessment using local referral pathways by a GP directly to a defined specialist (consultant gastroenterologist or consultant paediatric gastroenterologist) or to an age appropriate inflammatory bowel disease service. Specialist assessment enables consideration of a possible diagnosis of inflammatory bowel disease using a range of investigations. These include clinical evaluation and a combination of biochemical, endoscopic, radiological and histological investigations to confirm a diagnosis. [Expert opinion and British Society of Gastroenterology guidelines, section 3.3]
Within 4 weeks of referral
The timeframe of 4 weeks is based on expert consensus and is intended to be a safety net to ensure that no one waits longer than 4 weeks for specialist assessment. However, it is recognised that some people with suspected inflammatory bowel disease who have severe symptoms will need an urgent specialist assessment. In such cases ‘within 4 weeks’ is subject to clinical judgement and a considerably shorter timeframe may be necessary, for example within 2 weeks. Therefore an effective local referral pathway should ensure that people with suspected inflammatory bowel disease are seen within 4 weeks of referral, or more rapidly if clinically necessary. Services that already see patients earlier than 4 weeks from referral should maintain this speed of referral and assessment. [Expert opinion and IBD Standards, standard A4]

Equality and diversity considerations

The symptoms of inflammatory bowel disease may have a different impact on people of different gender, sexuality, culture and age. Referral processes and assessments need to be sensitive to individual anxieties and take into account any additional needs, such as the availability of doctors of the same sex, and any language barriers.

Multidisciplinary team support

This quality statement is taken from the inflammatory bowel disease quality standard. The quality standard defines clinical best practice in inflammatory bowel disease care and should be read in full.

Quality statement

Services provide age appropriate support from a multidisciplinary team for people with inflammatory bowel disease, and their family members or carers.

Rationale

Inflammatory bowel disease can have diverse effects on a person. In addition to its physical impact, there can be emotional, psychological and social consequences. A multidisciplinary team has a wide range of expertise that can help address these issues, and it is important that services for people with inflammatory bowel disease provide this support.

Quality measures

Structure
Evidence that services provide age appropriate support from a multidisciplinary team for people with inflammatory bowel disease, and their family members or carers.
Data source: Local data collection. Data on patient support and the inflammatory bowel disease team are available in the National audit of inflammatory bowel disease (IBD) service provision, sections 2 and 3, and the National audit of paediatric inflammatory bowel disease (IBD) service provision, sections 2 and 3.
Process
a) Proportion of people with inflammatory bowel disease where there is a documented discussion about their needs, and the needs of their family members or carers (if appropriate), for age appropriate support from a multidisciplinary team.
Numerator – the number in the denominator where there is a documented discussion about their needs, and the needs of their family members or carers (if appropriate), for age appropriate support from a multidisciplinary team.
Denominator – the number of people with inflammatory bowel disease.
Data source: Local data collection.
b) Proportion of people with inflammatory bowel disease whose needs, and the needs of their family members or carers (if appropriate), for age appropriate support from a multidisciplinary team are met.
Numerator – the number in the denominator whose needs, and the needs of their family members or carers (if appropriate), for age appropriate support from a multidisciplinary team are met.
Denominator – the number of people with inflammatory bowel disease whose needs for age appropriate support from a multidisciplinary team are recorded.
Data source: Local data collection.
Outcome
a) Satisfaction of people with inflammatory bowel disease with the support provided.
Data source: Local data collection. The Experience of inpatients with ulcerative colitis throughout the UK audit asks various questions about patient experience of support in hospital.
b) Satisfaction of family members or carers of people with inflammatory bowel disease with the support provided.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (district general hospitals) ensure that systems are in place so that people with inflammatory bowel disease, and their family members or carers, have age appropriate support from a multidisciplinary team.
Healthcare professionals work within a multidisciplinary team to provide age appropriate support to people with inflammatory bowel disease, and their family members or carers.
Commissioners (clinical commissioning groups) ensure that they commission services in which people with inflammatory bowel disease, and their family members or carers, have age appropriate support from a multidisciplinary team.

What the quality statement means for patients, service users and carers

People with inflammatory bowel disease, and their family members or carers, have support from a care team made up of a range of different professionals (including nurses, doctors, dietitians and pharmacists). The type of support they get should depend on the person’s age (for example, whether they are an adult or a child), and should help to deal with any concerns about the condition and its treatment.

Source guidance

Definitions of terms used in this quality statement

Age-appropriate support
Age appropriate support should be broad based and offered by those who are best placed at the time to meet the needs of people with inflammatory bowel disease and their family members or carers. A person's support needs will vary depending on age. For example, a child or young person's concerns might be more focused on body image, transition between services and attending school and higher education, whereas an adult might be more concerned with employment and sexual issues. Other issues for which people may need support include concerns about the disease and its treatment, nutrition and diet, and other aspects of living with a chronic illness. Support could include signposting to reliable and accurate information on a broad range of topics or having access to a dedicated telephone or email service where people can raise concerns or questions. [Adapted from Crohn's disease NICE guideline CG152 and IBD Standards, standard A11]
Multidisciplinary team
An inflammatory bowel disease multidisciplinary team should comprise gastroenterologists, colorectal surgeons and clinical nurse specialists with particular expertise and specialist interest in inflammatory bowel disease, a dietitian allocated to gastroenterology, and a pharmacist, pathologist and radiologist with special interest in gastroenterology. The team should have access to essential supporting services with an interest in inflammatory bowel disease, including a psychologist or counsellor, rheumatologist, ophthalmologist, dermatologist, obstetrician, nutrition support team, paediatric gastroenterology clinical network and general practice. There should be a named clinical lead for the inflammatory bowel disease team. [Adapted from IBD Standards, standards A1 and A2]

Surgery

This quality statement is taken from the inflammatory bowel disease quality standard. The quality standard defines clinical best practice in inflammatory bowel disease care and should be read in full.

Quality statement

People having surgery for inflammatory bowel disease have it undertaken by a colorectal surgeon who is a core member of the inflammatory bowel disease multidisciplinary team.

Rationale

Better patient outcomes are more likely if surgery for inflammatory bowel disease is undertaken by a colorectal surgeon with expertise and experience in inflammatory bowel disease surgery, with the support of an experienced clinical team. Such expertise is most likely to be in a unit where such surgery is performed regularly. The expertise and experience of the clinical team will enable the best judgement of when to undertake surgery, and should ensure the quality of clinical care before, during and after surgery.

Quality measures

Structure
Evidence of local arrangements to ensure that people having surgery for inflammatory bowel disease have it undertaken by a colorectal surgeon who is a core member of the inflammatory bowel disease multidisciplinary team.
Data source: Local data collection. Data on surgery for inflammatory bowel disease are available in the National audit of inflammatory bowel disease (IBD) service provision, section 3, and the National audit of paediatric inflammatory bowel disease (IBD) service provision, section 3.
Process
Proportion of surgical procedures for inflammatory bowel disease undertaken by a colorectal surgeon who is a core member of the inflammatory bowel disease multidisciplinary team.
Numerator – the number in the denominator undertaken by a colorectal surgeon who is a core member of the inflammatory bowel disease multidisciplinary team.
Denominator – the number of surgical procedures for inflammatory bowel disease.
Data source: Local data collection and Hospital episode statistics from The Health and Social Care Information Centre.
Outcome
Complications after surgery.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (district general hospitals and specialist tertiary centres) ensure that surgery for inflammatory bowel disease is undertaken by a colorectal surgeon who is a core member of the inflammatory bowel disease multidisciplinary team.
Healthcare professionals undertake inflammatory bowel disease surgery if they are colorectal surgeons with expertise and experience in such surgery, or refer people to a colorectal surgeon with relevant expertise and experience who is a core member of the inflammatory bowel disease multidisciplinary team.
Commissioners (clinical commissioning groups and NHS England) ensure that they commission services from providers who can demonstrate that surgery for inflammatory bowel disease is undertaken by colorectal surgeons who are core members of inflammatory bowel disease multidisciplinary teams.

What the quality statement means for patients, service users and carers

People who have surgery for inflammatory bowel disease have their operation carried out by a specialist surgeon called a colorectal surgeon who is a member of the inflammatory bowel disease care team. This will make it more likely that the operation is a success and ensure good care. Patients should always be involved in the decision to have surgery after a discussion of the benefits and risks.

Source guidance

Definitions of terms used in this quality statement

Surgery for inflammatory bowel disease
The types of operation performed for inflammatory bowel disease include colectomy, ileo–anal pouch procedure, ileostomy and intestinal resection. [Adapted from Crohn's disease NICE guideline CG152, Ulcerative colitis NICE guideline CG166 and British Society of Gastroenterology guidelines]
Colorectal surgeon who is a core member of the inflammatory bowel disease multidisciplinary team
The surgeon should have expertise and experience in undertaking surgery for inflammatory bowel disease and be able to make informed decisions about the need for surgery and the timing of surgery. Their predominant workload should involve inflammatory bowel disease and they should be a core member of the inflammatory bowel disease multidisciplinary team. Skilled and experienced surgeons, supported by an experienced clinical team, are most likely to be in units where such surgery is performed regularly.
When emergency procedures have to be performed, these may need to be done by a surgeon with the appropriate skills and experience who is available to perform the surgery. Children and young people should have their operations performed by surgeons with expertise in operating on children and young people with inflammatory bowel disease.
[Expert opinion and IBD Standards, standard A12]

Equality and diversity considerations

People from different cultures who need certain surgical procedures for inflammatory bowel disease, such as stoma operations, may need additional support if such procedures are not considered acceptable in their community.

Monitoring drug treatment

This quality statement is taken from the inflammatory bowel disease quality standard. The quality standard defines clinical best practice in inflammatory bowel disease care and should be read in full.

Quality statement

People receiving drug treatment for inflammatory bowel disease are monitored for adverse effects.

Rationale

People with inflammatory bowel disease may experience different responses to drug treatment, including adverse effects. How a person responds to drug treatment therefore needs to be monitored using local safety policies and procedures, and treatment adjusted to ensure the best quality of life outcomes and patient safety.

Quality measures

Structure
Evidence of documented local safety policies and procedures to monitor for adverse effects in people receiving drug treatment for inflammatory bowel disease.
Data source: Local data collection. Data on local protocols and monitoring arrangements for immunosuppressives are available in the National audit of inflammatory bowel disease (IBD) service provision, section 3, and the National audit of paediatric inflammatory bowel disease (IBD) service provision, section 3.
Process
Proportion of people receiving drug treatment for inflammatory bowel disease who are monitored for adverse effects.
Numerator – the number in the denominator for whom there is documented evidence that there is monitoring for adverse effects of drug treatment according to local safety policies and procedures.
Denominator – the number of people receiving drug treatment for inflammatory bowel disease.
Data source: Local data collection. Data on local protocols and monitoring arrangements for immunosuppressives are available in the National audit of inflammatory bowel disease (IBD) service provision, section 3, and the National audit of paediatric inflammatory bowel disease (IBD) service provision, section 3. Data on treatment follow up, acute reactions and adverse events are available in the results tables of the National clinical audit of biological therapies, Adult report and Paediatric report.
Outcome
The number of adverse events reported because of drug treatment for inflammatory bowel disease.
Data source: Local data collection. Data on adverse events are available in the results tables of the National clinical audit of biological therapies, Adult report and Paediatric report.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (general practices and district general hospitals) ensure that they have documented local safety policies and procedures that are used for monitoring for adverse effects in people receiving drug treatment for inflammatory bowel disease and for acting on abnormal results.
Healthcare professionals ensure that they monitor for adverse effects in people receiving drug treatment for inflammatory bowel disease, using documented local safety policies and procedures, and they act on abnormal results.
Commissioners (clinical commissioning groups and NHS England) ensure that they commission services in which there is monitoring for adverse effects in people receiving drug treatment for inflammatory bowel disease, using documented local safety policies and procedures, and abnormal results are acted on.

What the quality statement means for patients, service users and carers

People taking medication for inflammatory bowel disease have regular check ups for any side effects, and healthcare professionals take action if there are any concerns. This will lower the chances of the person having problems caused by the medication. People should be helped by their care team to understand treatment options and monitoring, including benefits, risks and possible consequences.

Source guidance

Definitions of terms used in this quality statement

Drug treatment for inflammatory bowel disease
A number of drugs are used to treat inflammatory bowel disease, depending on the type and severity of the disease, observed side effects, contraindications and patient preference. Drugs used include aminosalicylates, corticosteroids, biological treatments and immunosuppressives. Full details of treatment options for people with inflammatory bowel disease, including drug treatment, can be found in NICE guideline CG152 and NICE guideline CG166. [Adapted from Crohn's disease NICE guideline CG152 and Ulcerative colitis NICE guideline CG166]
Monitoring for adverse effects
Treatment of inflammatory bowel disease aims to induce remission and control symptoms. Monitoring for adverse effects should identify side effects and potential adverse outcomes from long term use. Treatments that can cause adverse outcomes include thiopurines, methotrexate, aminosalicylates, immunosuppressives and corticosteroids. [Adapted from Crohn's disease NICE guideline CG152 and Ulcerative colitis NICE guideline CG166]
Full details of side effects, contraindications and monitoring (including blood tests, procedures and clinical review) that should be carried out for specific drugs are detailed in the current online version of the British national formulary or British national formulary for children.
Local safety policies and procedures
There should be monitoring for adverse effects in people having drug treatment for inflammatory bowel disease using local safety policies and procedures. These should include:
  • shared care arrangements between primary and secondary care and clearly defined responsibilities for healthcare professionals in primary and secondary care
  • clear referral pathways
  • locally agreed monitoring guidelines
  • clear access routes to urgent care
  • a nominated member or members of the multidisciplinary team to act on abnormal results and reports of side effects and communicate with relevant healthcare professionals and people with inflammatory bowel disease (and/or their family members or carers, as appropriate). [Adapted from Crohn's disease NICE guideline CG152 and Ulcerative colitis NICE guideline CG166, and expert opinion]

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Implementation

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These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

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Pathway information

Important information about diagnosing irritable bowel syndrome

Confirming a diagnosis of irritable bowel syndrome is crucial. The primary aim should be to establish the person's symptom profile, with abdominal pain or discomfort being a key symptom. It is also necessary to establish the quantity and quality of the pain or discomfort, and to identify its site (which can be anywhere in the abdomen) and whether this varies. This distinguishes irritable bowel syndrome from cancer-related pain, which typically has a fixed site.
When establishing bowel habit, showing people the Bristol stool form scale may help them with description, particularly when determining quality and quantity of stool. People presenting with irritable bowel syndrome symptoms commonly report incomplete evacuation/rectal hypersensitivity, as well as urgency, which is increased in diarrhoea-predominant irritable bowel syndrome. About 20% of people experiencing faecal incontinence disclose their incontinence only if asked. People who present with symptoms of irritable bowel syndrome should be asked open questions to establish the presence of such symptoms (for example, 'tell me about how your symptoms affect aspects of your daily life, such as leaving the house'). Healthcare professionals should be sensitive to the cultural, ethnic and communication needs of people for whom English is not a first language or who may have cognitive and/or behavioural problems or disabilities. These factors should be taken into consideration to facilitate effective consultation.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Supporting information

Glossary

cognitive behavioural therapy
C-reactive protein
endomysial antibodies
erythrocyte sedimentation rate
full blood count
fermentable oligosaccharides, disaccharides, monosaccharides and polyols
selective serotonin reuptake inhibitors
tricyclic antidepressants
tissue transglutaminase

Paths in this pathway

Pathway created: October 2012 Last updated: June 2015

© NICE 2015

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