Introduction IBS is a common, chronic condition, incurring significant financial and time costs in both primary care and gastroenterology services. Symptoms may persist despite initial dietary, lifestyle and pharmacological interventions prompting referral for specialist gastroenterology input and investigation. Use of FC can exclude differential diagnoses such as inflammatory bowel disease without luminal investigation. Up to 75% of patients with IBS report symptomatic benefits with strict adherence to a low FODMAP diet,1 but this requires expert dietetic support. A pathway was indicated to facilitate direct access from primary care to specialist dietetic services for patients who do not require gastroenterologist review.
Methods Patients aged 16–45 with IBS symptoms according to Rome Criteria are eligible for this care pathway (Figure 1). In patients with persisting symptoms despite interventions as per NICE-guidance,2 FC informs further management. Patients with FC < 150 µg/g faeces can be referred to the dietetic-led refractory IBS service. This includes comprehensive symptom assessment, supported implementation of dietary exclusions with a low FODMAP diet followed by dietary re-challenge to identify triggers and optimise long-term IBS management. Patients with no symptomatic improvement following dietary manipulation are directly referred for gastroenterology review. Patients with an intermediate FC (51–149 µg/g faeces) undergo repeat FC after 3 months. Escalation of FC level prompts further investigation and consultant review. A consultant and specialist dietitian led education program was provided to regional GPs on practical implementation of the pathway.
Results The pathway and IBS service will be audited prospectively based on clinical outcomes, FC use in primary care and impact on referral to gastroenterology and endoscopy services.
Conclusion A comprehensive IBS care pathway and direct access service is now in place in Gloucestershire. Improvements to quality of care for IBS patients through provision of timely, appropriate and successful treatment options and prevention of unnecessary referral to gastroenterology and endoscopy services will be monitored.
References 1 Halmos, et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014;146:67–75
2 NICE. Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care. NICE Guidance CG61 February 2008. Guideline addendum 2015.
Disclosure of Interest None Declared