Referral criteria from primary care - irritable bowel syndrome

• referral for further assessment should be considered if there is doubt about the diagnosis or the patient becomes refractory to treatment (1)
• NICE suggest (2):
  • all people presenting with possible IBS symptoms should be asked if they have any of the following 'red flag' indicators and should be referred to secondary care for further investigation if any are present:
    • unintentional and unexplained weight loss
    • rectal bleeding
    • a family history of bowel or ovarian cancer
    • a change in bowel habit to looser and/or more frequent stools persisting for more than 6 weeks in a person aged over 60 years
  • all people presenting with possible IBS symptoms should be assessed and clinically examined for the following 'red flag' indicators and should be referred to secondary care for further investigation if any are present:
    • anaemia
    • abdominal masses
    • rectal masses
    • inflammatory markers for inflammatory bowel disease
    • note that if there is significant concern that symptoms may suggest ovarian cancer, a pelvic examination should also be considered

Reference:

1. Agrawal P, Whorwell J. Irritable bowel syndrome: diagnosis and management. BMJ 2006;332:280-3.
2. NICE (February 2015).Irritable bowel syndrome in adults - diagnosis and management of irritable bowel syndrome in primary care.