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Chronic abdominal pain or discomfort with bloating, diarrhoea or constipation is common. The symptoms can be caused by several different conditions, including irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Getting an accurate diagnosis is essential to managing the condition appropriately.

Diagnosis and management of irritable bowel syndrome

IBS is a common condition of the digestive system and the NICE guideline on irritable bowel syndrome in adults suggests that it affects 10–20% of people, mostly those aged between 20 and 30 years. It is twice as common in women as in men.

People with IBS report a range of abdominal symptoms that vary in severity and frequency and can be triggered by stress or eating certain types of food. It is an unpredictable, chronic condition that can 'flare up' for several months at a time.

In most cases, the diagnosis of IBS can be made on the basis of clinical history alone. The NICE guideline on irritable bowel syndrome in adults recommends that people presenting with abdominal pain, bloating or a change in bowel habit for at least 6 months should be asked if they have any 'red flag' indicators such as unexplained weight loss and rectal bleeding. They should also be examined and tested for anaemia, abdominal and rectal masses and inflammatory markers for IBD. People who do not have 'red flag' indicators but whose condition meets the IBS diagnostic criteria should have the following laboratory tests to exclude other diagnoses: a full blood count, an erythrocyte sedimentation rate or plasma viscosity, C‑reactive protein and antibody testing for coeliac disease. The next level of investigation involves endoscopy and imaging.

Treatment for IBS involves dietary and lifestyle advice and management of symptoms through medication.

Diagnosis and management of inflammatory bowel disease

IBD is a term used to describe a group of conditions that involve inflammation of the gastrointestinal tract (gut) such as ulcerative colitis and Crohn's disease. It is estimated that IBD affects about 1 in every 250 people in the UK. There are about 120,000 people with ulcerative colitis and 90,000 with Crohn's disease in the UK.

Symptoms for ulcerative colitis and Crohn's disease are similar and can include abdominal pain, recurring or bloody diarrhoea, weight loss, anaemia, extreme tiredness and nausea. IBD can be unpredictable and cause significant disruption to the person's quality of life and social functioning.

These conditions can sometimes have serious complications, including a high risk of surgery and an increased risk of colorectal cancer. In both ulcerative colitis and Crohn's disease some people have active disease but no symptoms.

The NICE quality standard for inflammatory bowel disease states that people with suspected inflammatory bowel disease should have a specialist assessment within 4 weeks of referral and that there should be local referral pathways to ensure this happens.

There is no cure for IBD and treatment aims to manage and relieve symptoms. An estimated 20% of people with ulcerative colitis have severe symptoms that often do not respond to treatment, and may need to have the inflamed section of their bowel removed.


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