NICE

The National Institute for Health and Clinical Excellence (NICE) recently spent over 18 months developing the first guidelines for the NHS in England and Wales on "Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care". The Gut Trust was represented on the Guideline Development Group, alongside clinicians, dieticians and psychologists, as well as GPs, health economists and one other patient representative. This is a document largely intended to assist GPs and practice nurses by informing them of treatments for IBS that can be supported by evidence.

The guidelines are based on available medical evidence. Many treatments that members of The Gut Trust have found useful are omitted because there just isn't enough evidence. For example, The Gut Trust is of the opinion that the holistic and patient-centred approach of most Complementary and Alternative Therapies can be of great benefit to many patients with IBS, but the NICE guidelines ignore these with the exception of hypnotherapy. The guidelines also recommend soluble fibre over and above insoluble fibre like wheat bran and wholemeal bread, though many of our members, particularly those with constipation find the latter useful. Aloe vera is another popular remedy. It has mild anti-inflammatory properties and many people have faith in it. Just the belief in a certain treatment can cure. The Gut Trust recognizes this and has adopted the policy of informing its members about available treatments, and supporting the use of self medication with treatments, which seem to make sense as long as they do no harm. The current enthusiasm for probiotics might be a case in point. The bran wagon may have come to a stop, overtaken by shiny new probiotics, but the evidence for the benefits of probiotics in IBS cannot be said to be convincing.

We welcome the fact that the NICE guidelines emphasize the importance of self-help, thereby endorsing the IBS Self Management Programme. We know from our experience that it is when people start to play an active part in the management of their own IBS, they often see a significant improvement. Indeed, the charity was founded on a network of self help groups. Our self-management programme was the first (and is still the only) web-delivered programme for helping people with IBS manage their own condition.

The advice about diet, exercise and medical interventions is useful. It is a peculiar feature of IBS treatment that the basic medications have all been around for a long time. This is partly because they work; and partly because newer treatments have not gained approval in the European Union for reasons of side effects and patient safety and have been either withdrawn or stringently reduced in the USA. We applaud the recommendations based on convincing evidence that low dose antidepressants and psychotherapy can be beneficial in serious cases of IBS since this underscores the importance of stress and the intimate connections between mind and gut.

And we are proud to have played our part.