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Practice Guidelines

Diagnosis and management of irritable bowel syndrome in adults in primary care: summary of NICE guidance

BMJ 2008; 336 doi: (Published 06 March 2008) Cite this as: BMJ 2008;336:556

This article has a correction. Please see:

  1. J Dalrymple, general practitioner1,
  2. I Bullock, director of National Collaborating Centre for Nursing and Supportive Care2
  1. 1Drayton & St Faith’s Medical Practice, Norwich NR8 6EE
  2. 2Royal College of Nursing, Oxford
  1. Correspondence to: J Dalrymple james.dalrymple3{at}

Why read this summary?

Irritable bowel syndrome (IBS) is a chronic, relapsing, and often lifelong condition of unknown aetiology,1 often associated with non-colonic symptoms. In clinical practice IBS is often diagnosed by the exclusion of more serious illnesses by unnecessary investigations and inappropriate referral. This article summarises the most recent guidance on IBS from the National Institute for Health and Clinical Excellence (NICE); the guidelines cover the diagnosis and management of the syndrome, reflecting the complete patient journey from presentation to positive diagnosis and management.2


NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the guideline development group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.


  • Consider the diagnosis of IBS if abdominal pain or discomfort, bloating, or a change in bowel habit are reported by the patient for at least six months. [Based on moderate quality evidence from cross sectional studies; on the experience of the Guideline Development Group (GDG); and on the work of Manning et al3 and the ROME III criteria4.]

  • All people presenting with possible IBS symptoms should be asked if they have any of the following “red flag” indicators; if they do, they should be referred to secondary care for further investigation (if cancer is suspected, see the NICE guideline 275). [Based on the NICE guideline 27 and the experience of the GDG.]

    • -unintentional and unexplained weight loss

    • -rectal bleeding

    • -a recent change in bowel habit to looser and/or more frequent stools that has persisted for more than six weeks in a patient aged over 60 years

    • -a family history of bowel or ovarian cancer

  • Patients should be assessed and clinically examined for the following red flag indicators …

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