To ensure continuity of care, multidisciplinary team working across primary and secondary care is essential. Patients will first present with IBD symptoms in primary care and simple screening will help determine if referral to secondary care is needed e.g. a faecal calprotectin test.

Stool tests

Stool tests are used to rule out other causes of diarrhoea and to measure faecal calprotectin (a neutrophil-derived protein present in faeces), the concentration of which is raised and measurable in the presence of gastrointestinal mucosal inflammation.

The faecal calprotectin test is inexpensive, low-risk, non-invasive and may be useful for distinguishing between irritable bowel syndrome (IBS) and IBD. It can also be used as a marker to monitor response to therapy but it lacks specificity to discriminate between IBD and other causes of bowel inflammation such as infectious diarrhoea.

Stool specimens should be obtained to exclude common pathogens and specifically assayed for C. difficile toxin. Additional tests may be tailored according to medical history, such as for those who have travelled abroad.

If a GP suspects an IBD patient is having a flare, they should not delay starting treatment unless symptoms are mild. To help assess if the patient is having a flare of their disease, blood tests as well as a stool test can be done in primary care.

Blood tests

Full blood count (FBC)

• A FBC may reveal thrombocytosis due to an inflammatory response, anaemia, and leucocytosis.

C-reactive protein (CRP)

• Serum CRP is useful for assessing a patient’s risk of relapse; however it may be raised for multiple reasons other than active IBD
• High levels may be indicative of active disease/inflammation or a bacterial complication. CRP generally correlates more with active disease in CD rather than UC
• CRP may not always be raised in active disease of either form of IBD, so should not be used as a sole marker for inflammation. 

Blood tests are required for monitoring drug treatments. For aminosalicylates these will be done in the community and frequency will depend on the brand of drug used.

Immunosuppressant treatment will always be initiated in secondary care and usually supply and monitoring will continue for at least three months until the patient is stable on an appropriate dose.