Spiller et al listed clinical findings which may indicate that a patient thought to have irritable bowel syndrome (IBS) should be referred to a gastroenterologist for an evaluation. The authors are from the Clinical Services Committee of the British Society of Gastroenterology.


Warning signs:

(1) presence of 2 or more nonspecific finding which may indicate underlying disease (see below)

(2) any uncertainty about the diagnosis

(3) failure to respond to appropriate therapy AND adherent

(4) psychological impairment because of the IBS

(5) significant disability or impaired quality of life because of the IBS


Findings which could indicate a significant problem:

(1) age > 50 years

(2) family history of colon cancer

(3) anemia

(4) rectal bleeding

(5) recent antibiotic therapy

(6) duration of symptoms < 6 months

(7) unexplained weight loss

(8) nocturnal symptoms


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