Organic Disease masquerading as IBS: an RCT in primary care: The Lincolnshire Poacher Study (Promoting Optimal Assessment to Change Health and Engineer an Economic Revolution

Project Description

Irritable bowel syndrome (IBS) affects up to 1 in 5 people in Britain. IBS can have a huge impact on a sufferer’s daily activities, general wellbeing, and overall health. IBS often carries major financial implications because of time lost from work, the cost of attending GP appointments and prescriptions. Sufferers also often report substantial extra ongoing costs for things like over-the-counter medicines, incontinence pads, deodorants, extra lavatory paper and laundry. And IBS does not just affect sufferers, their work, family and friendships. Treating IBS costs the NHS much more than £100 million annually.

The National Institute for Health and Care Excellence (NICE) guides how tests and treatments for diseases should be used. For IBS they recommend that the diagnosis can be made if someone has typical symptoms and normal results from four blood tests. More detailed tests used by specialists, NICE says, are not needed.

Once IBS is diagnosed, NICE recommends lifestyle and dietary changes and/or medicines although they admit that the evidence that these things help is weak. Indeed, NICE acknowledges that when their recommended treatments are used, at least half of sufferers continue with long term troublesome symptoms. The problem is that “typical IBS symptoms” and four blood tests are an unreliable way to distinguish patients with true IBS from those with other conditions which cause symptoms similar to IBS.

Evidence suggests that most people with constant or intermittent diarrhoea diagnosed as IBS in fact have a different diagnosis which the NICE recommended tests do not pick up. Examples of very treatable, often missed diagnoses and the number of affected people include: Sensitivity to fat in diet; Abnormal digestion of sugars; Germs living in parts of the bowel where there should be no germs; Microscopic bowel inflammation; Pancreas gland working inadequately.