PTU-123 Effectiveness of a dietetic-led IBS service in the management of patients over 45 years

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Abstract

Introduction

The low FODMAP diet is known to be effective in improving symptoms in approx. 70% of those with Rome criteria IBS. Whilst the majority of IBS patients are young adults, there is a cohort of patients over the age of 45 with IBS who may benefit from similar interventions. In January 2017, the dietetic-led refractory IBS (RIBS) Service in Gloucestershire expanded its direct access inclusion criteria to allow GP referral of patients >45 years with negative GI investigation within the previous 5 years and no change in symptoms. Consultant referrals following negative investigation in this age group are also accepted.

Methods

This is a retrospective analysis of data collected during patient consultations. Patients over 45 years referred to the RIBS service by GP or consultant were assessed and provided with detailed advice on a low FODMAP diet by a specialist dietitian, to be followed for 6 weeks. An 11 point symptom evaluation was completed before and after dietary manipulation and total scores were calculated. Typical bowel frequency and stool consistency were recorded, along with responses to a global symptom question ‘do you currently have satisfactory relief of your gut symptoms?’

Results

107 patients>45 years of age have completed treatment within the RIBS service (82% with diarrhoea or mixed symptom predominance). Individual and total symptom scores demonstrate an average reduction in severity of almost 50% after following a FODMAP exclusion diet (figure 1), with mean total symptom score before treatment 60.9 (range 27–89/110) reducing to 36.0 after treatment (range 11–89/110). Sixty-seven percent (72/107) of patients reported satisfactory relief of their gut symptoms following dietary restriction (figure 2). Direct-access patients who did not respond to treatment were discussed within a consultant-led MDT, with further advice, clinician review or investigation arranged as appropriate. No known cases of IBD or cancer have been missed to date using this pathway of care.

Conclusions

Treatment within a dietetic-led, direct-access service with an appropriate, policed care pathway and MDT support is a safe and clinically effective management strategy for patients over the age of 45 with diagnosed IBS symptoms. The pathway provides an important adjunct to ‘straight to test’ referral protocols for GP’s in those over 45 with stable symptoms and previously negative colonoscopy, diverting these patients from unnecessary specialist review and costly further investigation.

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