Inflammatory Bowel Disease Toolkit

Inflammatory Bowel Disease (IBD) affects at least 1 in 210 of the UK population and the prevalence is rising. Many patients report a delay in getting a diagnosis, the longer a diagnosis takes to make, the more likely a patient is to require aggressive medical therapy or even surgery.

Managing flares, supporting patients to stay well and monitoring long-term risks are all vital aspects of care.

This Inflammatory Bowel Disease Toolkit aims to be a 'one-stop-shop', a user-friendly guide to IBD for GPs and other primary care professionals.

Diagnosing IBD and the use of faecal calprotectin

Top tips

  1. Be aware that most patients are diagnosed in their teens and twenties, although IBD can develop in any age group from infants to the elderly
  2. Consider IBD in patients with unexplained fever, weight loss, anaemia, a family history of IBD or extra-intestinal manifestations (EIM) such as arthritis, erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis, uveitis, iritis or episcleritis).  Up to 50% of patients with IBD experience at least one EIM, which can present before IBD is diagnosed.
  3. Diarrhoea is the most common symptom, but this is not present in all adults or up to 44% of children with IBD in whom delayed growth and development may occur. Other symptoms can include weight loss, abdominal pain or cramping, bloating, lethargy, fevers, night sweats, and anaemia. Constipation can occur in some patients.
  4. The symptoms can overlap with many other lower gastrointestinal conditions, including bowel cancer, coeliac disease, endometriosis and ovarian cancer, and IBD can occur in patients with a previous diagnosis of Irritable Bowel Syndrome (IBS).
  5. Faecal calprotectin testing can help differentiate between IBD and Irritable Bowel Syndrome, facilitating appropriate referral, and is recommended by NICE – however, note that IBD can occur in patients with a previous diagnosis of Irritable Bowel Syndrome (IBS) whose symptoms change. Inflammatory markers and faecal calprotectin can both be negative in some patients, therefore consider referring patients with persistent symptoms.
  6. A quick response is essential in the case of a severe, acute flare-up, which carries a small risk of death due to sepsis or acute kidney injury.

Faecal calprotectin 

NICE diagnostics guidance 11 recommends faecal calprotectin testing as an option to support clinicians in differentiating between IBD and IBS in adults with recent-onset lower gastrointestinal symptoms if cancer is not suspected.  This approach is supported by the British Society of Gastroenterology

Examples of local referral pathways