Alarming features requiring specialist referral

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:

• signs and symptoms of cancer in line with the NICE guidance on recognition and referral for suspected cancer
• inflammatory markers for inflammatory bowel disease

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: Some examples of "red flags" include:

• anaemia
• abdominal masses
• rectal masses
• inflammatory markers for inflammatory bowel disease

If there is significant concern that symptoms may suggest ovarian cancer, a pelvic examination should also be considered (1).

Undertake Ca-125 if history suggestive of IBS in woman 50 years or over who has not had ovaries removed.

Reference:

• (1) NICE (February 2015).Irritable bowel syndrome in adults - diagnosis and management of irritable bowel syndrome in primary care.
• (2) NICE (April 2017).Irritable bowel syndrome in adults - diagnosis and management of irritable bowel syndrome in primary care.