suspected ibd (crohn’s / ulcerative colitis): primary care work-up + referral

Think IBD in persistent diarrhoea (especially nocturnal), rectal bleeding, weight loss, anaemia, raised inflammatory markers, perianal disease, or a strong family history. The primary care job is to (1) spot red flags, (2) exclude infection and cancer suspicion, and (3) use faecal calprotectin to support IBS vs IBD differentiation when cancer is not suspected.

• Acute severe colitis features: systemic toxicity (fever, tachycardia), severe abdominal pain/distension, dehydration, or suspected toxic megacolon → same-day hospital.
• Cancer suspicion: age and symptoms consistent with NG12 lower GI cancer pathways (e.g., weight loss, iron-deficiency anaemia, rectal mass) → follow suspected-cancer routes rather than “IBD work-up”.
• Complicated perianal disease (fistula/abscess) → urgent surgical/IBD assessment.

• Bloods: FBC (anaemia), CRP/ESR, U&E, LFTs, albumin, ferritin/iron studies, B12/folate if long-standing symptoms.
• Stool: culture if acute onset, travel, fever, or blood; consider C. difficile if recent antibiotics/hospital exposure.
• Coeliac screen if chronic diarrhoea or malabsorption features.
• Faecal calprotectin: useful in adults with recent-onset lower GI symptoms where cancer is not suspected; local thresholds vary, but many pathways use <100 µg/g (IBD unlikely), 100–250 (borderline/repeat), >250 (IBD more likely → refer).

Important: NSAIDs and acute infection can increase calprotectin; interpret in context and repeat if borderline after symptom settling.

• Routine/urgent gastro referral: persistent symptoms with raised calprotectin or objective inflammation, recurrent rectal bleeding, or concerning features despite negative infection screen.
• Time standard (QS81): people with suspected IBD should be assessed by a specialist within 4 weeks of GP referral.
• Include in referral: symptom timeline, stool frequency, bleeding pattern, weight trend, calprotectin value(s), blood results, infection tests, medication history, smoking status.