Policy Number: SRP 067
Policy Name: Irritable Bowel Syndrome Diagnostic Colonoscopy/Flexible Sigmoidoscopy-Calprotectin
Status: Group Prior Approval
Effective Date: 1 April 2024
Next Review Date: 1 April 2026
Mid and South Essex ICB commissions colonoscopy/flexible sigmoidoscopy for the diagnosis of irritable bowel syndrome on a restricted basis.
Calprotectin is a protein biomarker which is used in the differentiation of inflammatory bowel disease (IBD) from irritable bowel syndrome (IBS). This test supports the differentiation of those with IBS, who can be managed in primary care, and facilitates appropriate referral to secondary care of patients with IBD.
This policy does not cover those patients with the following red flag symptoms, who should be referred via a 2 week wait referral.
- Unintentional weight loss
- Family history of bowel or ovarian cancer
- Age >60 and a change in bowel habits lasting >6weeks
- Symptoms suggestive of ovarian pathology
Requests for endoscopy to diagnose IBS will not be funded unless the below process has been followed and evidenced within the patient’s referral.
Patients presenting with the following symptoms should be offered a calprotectin test:
- Abdominal pain relieved by defecation.
- Altered bowel frequency or consistency.
- Symptoms for at least 6months.
- No red flag symptoms
- Normal examination and blood tests
Patients with calprotectin levels <30ug/g should be managed as IBS patients in primary care. Irritable Bowel Syndrome (IBS) in adults; Treatment Pathway
Patients with calprotectin levels between 30-75ug/g should have a repeat test in 4 weeks. If the repeat test shows a calprotectin level of <30ug/g, the patient should be managed, as an IBS patient, in the primary care setting.
If the first test shows calprotectin level >75ug/g, or if the repeat test shows levels >30ug/g the patient should be referred to secondary care for inflammatory bowel disease.
Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.