Irritable bowel syndrome
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Suspected IBS without red flags (adult)
Laboratory tests
- FBC
- CRP
- IgA anti-tissue transglutaminase antibodies (tTG-IgA)if neededNICE requests this test in anyone who meets the criteria for IBS [2], and the initial work-up of the British Society of Gastroenterology includes it [3]. The ACG recommends it for IBS symptoms with diarrhoea [1,4], and the UEG/ESNM recommendation, which covers disorders with diarrhoea, includes it in its blood tests [5]. The reported prevalence of coeliac disease is higher in diarrhoea-predominant IBS than in constipation-predominant IBS [1].
- Total IgAif neededNICE requests this test in anyone who meets the criteria for IBS [2], and the initial work-up of the British Society of Gastroenterology includes it [3]. The ACG recommends it for IBS symptoms with diarrhoea [1,4], and the UEG/ESNM recommendation, which covers disorders with diarrhoea, includes it in its blood tests [5]. The reported prevalence of coeliac disease is higher in diarrhoea-predominant IBS than in constipation-predominant IBS [1].
Stool tests
Do not order
- ESR: no longer listed in the French fee schedule [7]; in France, only CRP is recommended in the initial tests [1]
- Routine TSH: not necessary for diagnosis in someone who meets the criteria for IBS [2]
- Routine stool parasitology or stool culture: not necessary for diagnosis [2]; the ACG advises against routine testing for stool pathogens [1]; likewise UEG/ESNM 2022, which reserves testing for Giardia (stool antigen or PCR) for exposed patients: travel to an endemic area, poor-quality water, camping, nursery [5]
- Faecal occult blood testing and hydrogen breath test to make the diagnosis: not necessary [2]
- Allergy or food intolerance tests (IgE, skin prick tests, food IgG panels) without reproducible allergic symptoms: not recommended; IgG panels are not validated [1]
- Routine colonoscopy before 45 years without alarm features [1]
- Faecal microbiota analysis (commercial tests): not recommended, its clinical value not being established [5]
Red flags: specialist advice and colonoscopy
- Refer to a gastroenterologist (colonoscopy to be discussed): rectal bleeding or melaena, unintentional weight loss, late onset of symptoms, family history of inflammatory bowel disease or colorectal cancer.
Laboratory tests
- FBC
- CRP
Sources (8)
- Sabaté JM. Recommandations sur la prise en charge du syndrome de l'intestin irritable (SII). POST'U 2022, FMC-HGE. Synthèse commentée des recommandations de l'American College of Gastroenterology (Lacy BE et al. Am J Gastroenterol. 2021;116(1):17-44, PMID 33315591) et de leur application en France.
- National Institute for Health and Care Excellence. Irritable bowel syndrome in adults: diagnosis and management. Clinical guideline CG61, février 2008, mise à jour 2017 ; chapitre Recommendations, consulté le 11 octobre 2026.
- Ebell MH. British Society of Gastroenterology Guidelines for the Management of Irritable Bowel Syndrome. Am Fam Physician. 2022;105(6):en ligne (résumé « POEM » de : Vasant DH, Paine PA, Black CJ, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021;70(7):1214-1240).
- Lacy BE, Pimentel M, Brenner DM, Chey WD, Keefer LA, Long MD, Moshiree B. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021;116(1):17-44.
- Savarino E, Zingone F, Barberio B, et al. Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility. United European Gastroenterol J. 2022;10(6):556-584.
- National Institute for Health and Care Excellence. Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel. Diagnostics guidance DG11 (octobre 2013), devenue HealthTech guidance HTG320 ; consulté le 11 octobre 2026.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 1684 (calprotectine fécale) et 1828 (anticorps anti-transglutaminase IgA) ; absence d'acte actif pour la VS.
- Fukudo S, Okumura T, Inamori M, Okuyama Y, Kanazawa M, Kamiya T, et al. Evidence-based clinical practice guidelines for irritable bowel syndrome 2020 (Japanese Society of Gastroenterology). J Gastroenterol. 2021;56(3):193-217.