Intended for healthcare professionals

Practice Guidelines

Irritable bowel syndrome in adults in primary care: summary of updated NICE guidance

BMJ 2015; 350 doi: (Published 25 February 2015) Cite this as: BMJ 2015;350:h701
  1. Cheryl Hookway, technical analyst1,
  2. Sara Buckner, technical analyst2,
  3. Paul Crosland, health economist2,
  4. Damien Longson, consultant liaison psychiatrist3
  1. 1National Institute for Health and Care Excellence, Clinical Guideline Updates Team, Manchester M1 4BT, UK
  2. 2National Institute for Health and Care Excellence, Clinical Guideline Updates Team, London, UK
  3. 3Department of Psychiatry, Manchester Mental Health and Social Care Trust, Manchester, UK
  1. Correspondence to: C Hookway cheryl.hookway{at}

The bottom line

  • Consider using the low FODMAP diet for patients whose irritable bowel syndrome symptoms persist despite following general lifestyle and dietary advice from a healthcare professional with relevant expertise

  • Consider linaclotide (laxative) for people with chronic constipation if other laxatives haven’t worked and they have had constipation for at least 12 months, but ensure adequate follow-up to evaluate its effectiveness

  • Consider tricyclic antidepressants (TCAs) if laxatives, loperamide, or antispasmodics have not helped, and then selective serotonin reuptake inhibitors if TCAs are ineffective

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder with an estimated prevalence of 10-20%.1 The condition mostly affects people aged 20-30 years and is twice as common in women as in men.1 It can be painful and debilitating, lead to feelings of anxiety and depression, and negatively affect quality of life.1

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on irritable bowel syndrome in adults in primary care.2


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. Where the evidence was minimal, recommendations in the original guidance were based on the guideline development group’s experience and opinion of what constitutes good practice. Changes in this update are based on evidence from updated systematic reviews and updated evidence on cost effectiveness. Evidence levels for the recommendations are given in italic in square brackets.

Initial assessment

  • Consider assessment for IBS if the person reports having had any of the following symptoms for at least six months:

    • -Abdominal pain or discomfort

    • -Bloating

    • -Change in bowel habit.

  • Ask all people presenting with possible symptoms of IBS if they have any of the following “red flag” indicators and refer them to secondary care for further investigation if any are present:

    • -Unintentional and unexplained weight …

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