Introduction

This quality standard covers the diagnosis and management of irritable bowel syndrome in adults. It does not cover other gastrointestinal disorders such as non‑ulcer dyspepsia, coeliac disease and inflammatory bowel disease. For more information see the irritable bowel syndrome topic overview.

Why this quality standard is needed

Irritable bowel syndrome is a chronic, relapsing and often life‑long disorder. It is characterised by abdominal pain or discomfort, which may be relieved by defaecation or accompanied by a change in bowel habit. Symptoms may include constipation or diarrhoea or both, and abdominal distension, usually referred to as bloating. People present with varying symptom profiles, most commonly 'diarrhoea predominant', 'constipation predominant' or mixed symptom (alternating between diarrhoea and constipation). Symptoms sometimes overlap with other gastrointestinal disorders such as non‑ulcer dyspepsia or coeliac disease.

The causes of irritable bowel syndrome have not been adequately defined, although gut hypersensitivity, disturbed colonic motility, bowel dysfunction after an infection, microbial imbalance in the gut (dysbiosis), low‑grade inflammation or a defective antinociceptive (anti‑pain) system are possible causes. Stress commonly aggravates the disorder.

Irritable bowel syndrome may cause lack of sleep, anxiety and lethargy, which may lead to time off work, avoidance of stressful or social situations, and a significant reduction in quality of life.

The quality standard is expected to contribute to improvements in the following outcomes:

  • undiagnosed irritable bowel syndrome in adults

  • quality of life for adults with irritable bowel syndrome

  • satisfaction with care received for irritable bowel syndrome

  • unnecessary hospital attendances for symptoms of irritable bowel syndrome

  • inappropriate investigations.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

Improving functional ability in people with long‑term conditions

2.2 Employment of people with long‑term conditions*, **

4 Ensuring that people have a positive experience of care

Overarching indicators

4a Patient experience of primary care

i GP services

4d Patient experience characterised as poor or worse

I Primary care

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Improving access to primary care services

4.4 Access to i GP services

Improving people's experience of integrated care

4.9 People's experience of integrated care**

Alignment with Adult Social Care Outcomes Framework and/or Public Health Outcomes Framework

* Indicator is shared

** Indicator is complementary

Indicators in italics in development

Table 2 Public health outcomes framework for England, 2013–16

Domain

Objectives and indicators

1 Improving the wider determinants of health

Objective

Improvements against wider factors that affect health and wellbeing and health inequalities

Indicators

1.8 Employment for those with long‑term health conditions including adults with a learning disability or who are in contact with secondary mental health services*,**

1.9 Sickness absence rate

2 Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicators

2.11 Diet

2.23 Self‑reported well‑being

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities

Indicators

4.13 Health‑related quality of life for older people

Alignment with Adult Social Care Outcomes Framework and/or NHS Outcomes Framework

* Indicator is shared

** Indicator is complementary

Patient experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to irritable bowel syndrome.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to patients and service users. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development sources for quality standards that affect patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for irritable bowel syndrome specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole irritable bowel syndrome care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to people with irritable bowel syndrome.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality irritable bowel syndrome service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating adults with irritable bowel syndrome should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with irritable bowel syndrome. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.