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Rational Investigations in Irritable Bowel Syndrome
Irritable Bowel Syndrome is a functional gastrointestinal disorder with an estimated prevalence of around 10%. The approach to investigation is variable and influenced by the symptom severity, clinician experience and the clinical setting but based around the principle of careful clinical assessment, early diagnosis and limiting to necessary and relevant tests. In this issue Christopher Black and Alexander Ford summarise the evidence base and provide practical guidance. Diagnostic criteria should be present as per the Rome Criteria. Routine bloods are acceptable but have a low diagnostic yield. Coeliac testing is reasonable. Faecal Calprotectin should be considered, especially if there is diarrhoea, proceeding to colonoscopy if the test is positive. More intensive investigation should be reserved for specific cases and dependant on the history, examination and red flags if present. Colonoscopy should be considered in any patient with alarm features for colorectal cancer or if microscopic colitis is suspected (even if the calprotectin is normal). If bile acid diarrhoea is suspected then 23-seslo-25-homotaurocholic acid (SeHCAT) scanning should be considered. Breath testing and testing for small intestinal bacterial overgrowth are not helpful and a trial of treatment …