Lower gastrointestinal symptoms are very common. They are challenging both for patients and GPs because different diseases can cause them. It can be difficult to distinguish between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), as symptoms are often similar.
This similarity does not only cause delay in an accurate diagnosis for those suffering with IBD, but can subject those with IBS to unnecessary and costly investigations and treatment such as colonoscopy.
IBS affects 10 to 20 per cent of the population and is safely treated in primary care. IBD affects about one in 250 people and encompasses serious conditions where early recognition is required and major surgery may be needed, for example Crohn’s disease and ulcerative colitis. While both IBS and IBD present with the same symptoms, only three per cent of the population that present in primary care will have IBD.
Faecal calprotectin stool test is an established simple, non-invasive and cost efficient investigation for GPs to use when a patient first presents in primary care. The result will help determine whether the patient needs to be referred on to secondary care for further testing or treatment, i.e. a colonoscopy, or whether an urgent referral to secondary care is appropriate for suspected IBD.
The updated pathway
While the faecal calprotectin test is recommended by NICE, no guidance has been given on the threshold levels for treatment in primary care for IBS, or referral to secondary care for possible IBD. Until now!
A recent evidence-based study undertaken in York, in conjunction with the NHS Vale of York CCG, has recommended revised threshold markers which are contained in the revised pathway. This pathway is approved by NICE and NHS England and is available here.
National roll-out of the revised pathway is being led by Yorkshire and Humber AHSN. Locally, the pathway is supported by clinical leads across Bristol, North Somerset and South Gloucestershire (BNSSG) and it has been adopted across all GP practices in the BNSSG footprint.
Guidance on the use of the revised pathway is contained in this short film, where Charlie Andrews, GP at the Mendip Vale Medical Group and Regional Clinical Champion for IBD with the Royal College of General Practitioners (RCGP), guides us through the pathway and highlights key learning points.
For further information, contact Dave Evans, Programme Manager at David.Evans@weahsn.net or 0117 900 2249.