Quality statement 1: Excluding inflammatory causes

Quality statement

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

Rationale

Irritable bowel syndrome can be difficult to diagnose because the 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.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with symptoms of irritable bowel syndrome are offered tests for inflammatory markers as first‑line investigation to exclude inflammatory causes.

Data source: Local data collection.

Process

Proportion of adults with symptoms of irritable bowel syndrome who have tests for inflammatory markers as first‑line investigation to exclude inflammatory causes.

Numerator – the number in the denominator who have tests for inflammatory markers as first‑line investigation to exclude inflammatory causes.

Denominator – the number of adults with symptoms of irritable bowel syndrome.

Data source: Local data collection.

Outcome

Number of adults diagnosed with irritable bowel syndrome.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (GP practices) ensure that systems are in place for adults with symptoms of irritable bowel syndrome to be offered tests for inflammatory markers (including faecal calprotectin and C‑reactive protein) as first‑line investigation to exclude inflammatory causes of symptoms.

Healthcare professionals in primary care (GPs)offer adults with symptoms of irritable bowel syndrome tests for inflammatory markers (including faecal calprotectin and C‑reactive protein) as first‑line investigation to exclude inflammatory causes of symptoms.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services that offer tests for inflammatory markers (including faecal calprotectin and C‑reactive protein) to adults with symptoms of irritable bowel syndrome, as first‑line investigation to exclude inflammatory causes of symptoms.

What the quality statement means for patients, service users and carers

Adults with symptoms of irritable bowel syndrome (such as constipation, diarrhoea and bloating) are offered blood and stool sample tests to check whether they have inflammation in their bowel. This will help their GP to find out what might be causing their symptoms and to diagnose their condition.

Source guidance

Definitions of terms used in this quality statement

Symptoms of irritable bowel syndrome

Irritable bowel syndrome should be considered if an adult presents with abdominal pain or discomfort, bloating or a change in bowel habit for at least 6 months. A diagnosis of irritable bowel syndrome should be considered only if the person has abdominal pain or discomfort that is either relieved by defaecation or is associated with altered bowel frequency or stool form. This should be accompanied by at least 2 of the following 4 symptoms:

  • altered stool passage (straining, urgency, incomplete evacuation)

  • abdominal bloating (more common in women than men), distension, tension or hardness

  • symptoms made worse by eating

  • passage of mucus.

Lethargy, nausea, backache and bladder symptoms are also common in people with irritable bowel syndrome, and may be used to support the diagnosis.

[Adapted from Irritable bowel syndrome in adults (NICE guideline CG61), recommendations 1.1.1.1 and 1.1.1.4 (key priorities for implementation)]

Tests for inflammatory markers

Tests for inflammatory markers to exclude inflammatory causes include tests for faecal calprotectin and C‑reactive protein. Inflammatory causes are usually excluded to help the diagnosis of mixed symptom (alternating between diarrhoea and constipation) or diarrhoea‑predominant irritable bowel syndrome.

[Adapted from Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel (NICE diagnostics guidance DG11), recommendation 1.1; Irritable bowel syndrome in adults (NICE guideline CG61), recommendations 1.1.1.3 and 1.1.2.1 (key priorities for implementation); and expert opinion]

Inflammatory causes

Chronic diseases that cause inflammation of the digestive system, such as Crohn's disease and ulcerative colitis.

[Adapted from Inflammatory bowel disease (2015) NICE quality standard 81, introduction]