Guidance on how to diagnose and treat irritable bowel syndrome (IBS) in adults has been released by the National Institute of Health and Care Excellence (NICE).

Nurses should test for inflammatory markers first (including faecal calprotectin and c‑reactive protein), because IBS symptoms can be similar to other conditions such as inflammatory bowel disease and coeliac disease.

“Tests for inflammatory markers are particularly useful to exclude inflammatory bowel disease and mean that fewer people have invasive procedures (such as colonoscopies and sigmoidoscopies) to check for inflammatory causes of their symptoms,” the guidance read.

Once “red flag indicators” and other causes of symptoms, such as coeliac disease, have been ruled out, a positive diagnosis of IBS can be made. This will also help to reduce unnecessary anxiety for patients with IBS symptoms.

If symptoms persist after an agreed time, make sure the patient has been offered advice on further dietary management from healthcare professionals with relevant expertise.

The four quality statements

Statement 1:

Adults with symptoms of IBS are offered tests for inflammatory markers as first‑line investigation to exclude inflammatory causes.

Statement 2:

Adults with IBS symptoms are given a positive diagnosis if no red flag indicators are present and investigations identify no other cause of symptoms.

Statement 3:

Adults with IBS are offered advice on further dietary management if their symptoms persist after they have followed general lifestyle and dietary advice.

Statement 4:

Adults with IBS agree their follow‑up with their healthcare professional.

To see the full guidance click here.