Referral pathways

Referral pathways

Statement 2.1

Clear pathways and protocols for investigating children and adults with persistent lower gastrointestinal symptoms should be agreed between primary and secondary care and should include guidance on the use of faecal biomarker tests in primary care to aid rapid diagnosis.

Why is it important?

Many people are waiting too long for an Inflammatory Bowel Disease (IBD) diagnosis. According to a survey by Crohn’s & Colitis UK almost half of patients take one year to get diagnosed – with nearly one in five people waiting over five years.

This is distressing for patients, who face painful and debilitating symptoms without a name – or effective treatment – for their condition.

And it’s damaging for the NHS. Delayed diagnosis results in higher likelihood of surgery, more expensive treatments, and a poorer prognosis1.

Some GPs find it difficult to identify potential IBD, as the symptoms often overlap with other conditions, such as Irritable Bowel Syndrome (IBS) and can be atypical, especially in children2. This is where referral pathways can help. Clear pathways and protocols, including the use of faecal biomarkers in adults, can speed up diagnosis and lead to better patient outcomes. Children should be referred to the nearest specialist children's service.

Guidance and further information

Faecal calprotectin

NICE diagnostics guidance 11 recommends faecal calprotectin testing as an option to support clinicians in differentiating between IBD and IBS in adults with recent-onset lower gastrointestinal symptoms if cancer is not suspected. This approach is supported by the British Society of Gastroenterology. Please see below for links to further guidance, including local referral pathways.

Examples of local referral pathways

South East London Area Prescribing Committee

Primary & Secondary Care Inflammatory Bowel Disease Pathway

Click here

For years I was misdiagnosed with skin conditions and allergies – it only was after finally getting a faecal calproctectin test that I was diagnosed with Colitis. One year later, I'm in remission and getting on with my life.

Megan, age 25, diagnosed with Ulcerative Colitis