NHD CPD eArticle Volume 9.02 - 8th February 2019
IBS: SETTING UP A PATIENT SERVICE
IBS is a long-term condition affecting the digestive tract. It can most commonly cause symptoms such as abdominal discomfort, an altered bowel habit and bloating, and can have a huge impact on a patient’s quality of life. It is known that diet and lifestyle factors play a huge role in managing symptoms, hence why NICE guidance on management of IBS suggests the use of avoidance and exclusion diets to only be advised by a healthcare professional with expertise in dietary management.1 When looking at the low-FODMAP diet more specifically, which is used as second-line treatment for IBS, studies have supported dietitians being the healthcare professionals to deliver the dietary guidance, stating that dietitians have an extensive knowledge of nutrition, health and disease and are the leading experts in educating patients on disease-specific dietary management, including IBS.2 One study concluded that dietetic-led implementation of the low-FODMAP diet is an effective strategy for the management of IBS and that the trend for non-dieteticled implementation of the diet is of concern, as there is no evidence of the clinical effectiveness or risks associated with such practices. The study also stressed the importance
Rebecca has a keen interest and specialises in gastroenterology dietetics. She currently works in the community setting in the Chester area, running clinics and group sessions to manage a wide range of gastroenterology conditions.
The IBS pathway discussed in this article can be viewed at www. NHDmag. com/ibspathway.html
of dietetic-led management in IBS needing an increased recognition in clinical practice.2 Despite the evidence, it is thought that IBS referrals account for up to 60% of outpatient gastroenterology referrals.3,4 By using a thorough referral system to rule out other potential gastrointestinal causes, a dietetic-led clinic with access to a gastroenterologist is suitable to manage this patient group. AIMS OF THE IBS SERVICE
The aim of the IBS service at Chester was to ultimately reduce the pressure from the gastroenterology consultants, who were finding that a large amount of their clinical time was being spent with IBS patients. They would often refer these patients onto the dietitians after seeing them initially. Reducing consultant pressure would lead to a reduction in consultant wait times, as well as patient wait times to be treated, with the aim that patient satisfaction would, therefore, increase. The pathway also hoped to reduce unnecessary investigations, such as colonoscopies. The policy aimed for patients to be seen within four weeks of receiving the referral, and that they would be seen by a dietitian before, or instead of, seeing a consultant. It was made
Rebecca Gasche Registered Dietitian, Countess of Chester Hospital NHS Trust
When I started my post in April 2016, my initial task was to help set up a dietetic-led irritable bowel syndrome (IBS) service. Following on from successful dietetic-led coeliac services, my Trust wanted to create a similar pathway for patients with IBS, to help reduce pressures in secondary care, wait times and improve patient outcomes.
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