Organic disease masquerading as irritable bowel syndrome: a randomized controlled trial in primary care: the Lincolnshire POACHER study (Promoting Optimal Assessment to Change Health and Engineer an Economic Revolution)
Irritable bowel syndrome
Randomisation will be performed independently by the Hull Health Trials Unit: Arm 1: Controls: standard GP treatment following NICE guidance for the treatment of IBS-like symptoms. Arm 2: Intervention arm: experimental investigations and treatments, nurse-led treatment following checklists and arranging additional investigations. The patients will be followed for 1 year following randomisation. Treatment will be given as necessary in both arms. The primary endpoint will be improvement in symptoms at 1 year.
Patients presenting to the GP with IBS-like symptoms characterised by intermittent or constant loose stool
1. Unexplained weight loss, rectal bleeding, fever, anaemia, palpable mass or sudden unexplained onset of symptoms 2. Previous referral for chronic GI symptoms to a gastroenterologist or GI surgeon 3. Previous cholecystectomy 4. Previous gastrointestinal surgery of any type except appendicectomy, abdominal wall or femoral hernia repair or diagnostic laparoscopy without surgical intervention 5. Past history of inflammatory bowel disease, coeliac disease, chronic liver or pancreatic disease 6. Past history of cancer (except basal cell carcinoma) 7. Consultation with any health professional in the last 5 years for abnormal GI symptoms 8. Previous investigations in secondary care for IBS-like symptoms