PTU-081A Initial experience of a nurse-led irritable bowel syndrome clinic

• Published in: Gut Vol. 66; no. Suppl 2; p. A91
• Main Authors: Neilson, M, Caulfield, L, Morris, AJ, Gaya, D, Winter, J, Cahill, A, Lachlan, N, Stanley, AJ, Forrest, E, Gillespie, R, Barclay, S, Smith, LA
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2017
• Subjects: Bile; Clinics; Colitis; Colon; Colonoscopy; Constipation; Diagnosis; Disease management; Dyspepsia; Endoscopy; Gastritis; Gastroenterology; Gluten; Inflammatory bowel disease; Intolerance; Irritable bowel syndrome; Kidney cancer; Lactose; Malabsorption; Ovarian cancer; Ovarian carcinoma; Pain; Patients; Renal cell carcinoma; Schistosomiasis; Sigmoidoscopy; Small intestine
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2017-314472.176

IntroductionIrritable bowel syndrome (IBS) is a common indication for Gastroenterology referral.We launched a “one-stop” nurse-led clinic for the diagnosis and management of patients with suspected IBS.MethodWith the assistance of a pump priming grant an IBS Clinical Nurse Specialist (CNS) was recruited and trained by the lead gastroenterologist and community dieticians.GP referrals of patients under 50y with symptoms consistent with IBS without “red flag” symptoms were identified as suitable to be assessed in the clinic.Three clinics per week were established with consultation times of 30 min per patient. A ‘Suspected IBS Protocol’ for investigation and management was followed.Data on the final diagnosis, management and re-referral rates were collected prospectively.ResultsInitial analysis is of 18 months of the service. 389 patients were identified, 48 (12%) failed to attend.Of the 341 patients reviewed 252 (74%) were female and 89 (26%) male. Median age was 32. 67 patients (20%) required further investigation in the form of colonoscopy/flexible sigmoidoscopy/upper GI endoscopyThe final diagnosis was IBS in 264 patients (77%); of which153 (58%) had IBS-D; 61 (23%) had IBS-C; 46 (17%) had IBS-M and 4 (2%) had post infectious IBS. 52 (15%) of patients had alternative diagnosis made: functional abdominal pain 15 (4.4%); Helicobacter Pylori 7 (2.1%); chronic constipation 6 (1.8%); bile salt malabsorption 4 (1.2%), diverticulosis 3 (0.9%); Crohn’s colitis 2 (0.6%); Colonic schistosomiasis 1 (0.3%); small bowel Crohn’s 1 (0.3%); lactose intolerance 1 (0.3%); gastritis 1 (0.3%), ovarian carcinoma 1 (0.3%); renal carcinoma 1 (0.3%); lymphocytic colitis 1 (0.3%); functional dyspepsia 1 (0.3%); non-coeliac gluten intolerance 1 (0.3%); inappropriate vetting 3 (0.9%). Two (0.6%) patients symptoms had resolved completely prior to review and 1 (0.3%) patient refused consultation. 12 (3.5%) patients defaulted from colonoscopy and have an unclear final diagnosis, 9 (2.6%) of patients failed to supply a stool sample for faecal calprotectin analysis therefore have an unclear final diagnosis. Dietary and lifestyle advice was provided to all patients. Medications were suggested in 140 patients (41%). 4 (1.1%) patients are awaiting investigation. 4 patients (1.1%) have been referred back to the IBS clinic by GP with unresolved symptoms.ConclusionThe service has been successful in confirming the diagnosis of IBS in the majority of patients. Only a small number have needed referral back to the service.The advantages of this service are that patients see a specially trained individual with the expertise and time required to manage them and facilitate discharge back to primary care.Diverting these patients to a CNS clinic can help reduce waiting times for consultant clinics.Disclosure of InterestNone Declared