{"id":3693,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/alteredbowelhabit\/"},"modified":"2026-08-18T08:11:46","modified_gmt":"2026-08-18T07:11:46","slug":"lowergisymptoms","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/lowergisymptoms\/","title":{"rendered":"Lower GI Symptoms (Not acutely unwell)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<div data-wp-interactive=\"core\/file\" class=\"wp-block-file\"><object data-wp-bind--hidden=\"!state.hasPdfPreview\" hidden class=\"wp-block-file__embed\" data=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Lower-GI-AUGUST-2026-FLOWCHART.pdf\" type=\"application\/pdf\" style=\"width:100%;height:930px\" aria-label=\"Embed of Lower GI AUGUST 2026 FLOWCHART.\"><\/object><a id=\"wp-block-file--media-a633a268-7ac2-4bde-8bd1-32d50b86ca46\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Lower-GI-AUGUST-2026-FLOWCHART.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Lower GI AUGUST 2026 FLOWCHART<\/a><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Lower-GI-AUGUST-2026-FLOWCHART.pdf\" class=\"wp-block-file__button wp-element-button\" download aria-describedby=\"wp-block-file--media-a633a268-7ac2-4bde-8bd1-32d50b86ca46\">Download<\/a><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>JB, RC, SD, FD &#8211; 17-8-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li>For&nbsp;<strong>Colorectal Cancer Referrals<\/strong>&nbsp;please see guidance&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/colorectal\/colorectalcancer\/\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a><\/li>\n\n\n\n<li>For&nbsp;<strong>Ovarian Cancer Referrals<\/strong>&nbsp;please see guidance&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/ovarianpathology\/ovariancancer\/\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a><\/li>\n\n\n\n<li>For&nbsp;<strong>Inflammatory Bowel Disease Referrals&nbsp;<\/strong>please see guidance&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/inflammatoryboweldisease\/\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a><\/li>\n\n\n\n<li>For&nbsp;<strong>Coeliac Disease Referrals&nbsp;<\/strong>please see guidance&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/coeliac\/\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a><\/li>\n\n\n\n<li>For&nbsp;<strong>Irritable Bowel Syndrome Referrals&nbsp;<\/strong>please see guidance&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/irritablebowelsyndromeibs\/\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a><\/li>\n\n\n\n<li>For&nbsp;<strong>Diverticular Disease Referrals&nbsp;<\/strong>please see guidance&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/colorectal\/diverticulardisease\/\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">For any other referrals to Gastroenterology regarding lower GI symptoms&nbsp;<strong>that do not fit into one of the referral pathways above<\/strong>&nbsp;then referrals can be sent to:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>RIE &gt;&gt; Gastroenterology \u2013 Medical &gt;&gt; GI Lower<\/li>\n\n\n\n<li>SJH &gt;&gt; Gastroenterology \u2013 Medical &gt;&gt; GI Lower<\/li>\n\n\n\n<li>WGH &gt;&gt; Gastroenterology \u2013 Medical &gt;&gt; GI Lower<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please note that the only referral priorities for this referral route are Routine or Urgent. There is no option for USC referral.<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color wp-block-paragraph\"><strong>PLEASE DO NOT SEND ANY URGENT SUSPICION OF CANCER REFERRALS VIA THE ABOVE ROUTE. ANY REFERRAL FOR LOWER GI SYMPTOMS WHERE THERE IS A QUERY OF CANCER SHOULD BE SENT TO THE COLORECTAL TEAMS AS PER THE GUIDANCE ON THE <\/strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/colorectal\/colorectalcancer\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp COLORECTAL CANCER PAGE<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Basic investigations in Primary Care \u2013 Blood tests<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>FBC, Ferritin (+\/- Iron and transferrin)<\/li>\n\n\n\n<li>Cr&amp;Es, LFTs, Ca, Alb, TFTs<\/li>\n\n\n\n<li>CRP<\/li>\n\n\n\n<li>Coeliac screen: patients must not eliminate or reduce gluten from their diet<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">\u200bBasic investigations in Primary Care \u2013 Stool tests<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Stool sample for C&amp;S including parasitology &#8211; in NHS Lothian, all diarrhoeal stools from patients \u22653 years old will automatically be tested for C Diff.<\/li>\n\n\n\n<li>Faecal calprotectin (FCP) (<strong>those under 50 years old<\/strong>)* if appropriate &#8211; see guidance on IBD page<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">* Please remember that FCP is <strong>not <\/strong>a test for Colorectal Cancer. If you have any concerns re CRC please refer via the appropriate pathway: <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/colorectal\/colorectalcancer\/\" target=\"_blank\" rel=\"noreferrer noopener\">Colorectal Cancer<\/a>. FCP can be a marker for IBD but can also rise in gut infections and with some medications. Please see guidance on the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/inflammatoryboweldisease\/\" target=\"_blank\" rel=\"noreferrer noopener\">IBD<\/a> page for how to interpret a raised FCP.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please note that in National Guidance reference is made to using FIT in Primary Care &#8211; in NHS Lothian if this is indicated it will be arranged by secondary care in response to a USC referral via the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/colorectal\/colorectalcancer\/\" target=\"_blank\" rel=\"noreferrer noopener\">Colorectal Cancer referral pathway<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>4-week Watch &amp; Wait Policy<\/strong> to see if the condition is self-limiting, is reasonable in those with<strong> Low-risk features<\/strong> such as:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Transient symptoms (less than 4 weeks)<\/li>\n\n\n\n<li>Patients <strong>under 40 years<\/strong> in absence of high-risk features<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>In these cases consider:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Assessment and review<\/li>\n\n\n\n<li>Consider bowel diary<\/li>\n\n\n\n<li>Appropriate information, counselling and agreed plan for review with GP<\/li>\n\n\n\n<li>Refer if symptoms persist or recur \u2013 see information in Safety netting box above<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">The What\u2019s up with my Gut website has helpful information for patients. The videos about how to correctly get a stool sample can be useful to share with patients:<br><a href=\"https:\/\/www.youtube.com\/watch?v=h-D3jmS6BfM&amp;t=1s\" target=\"_blank\" rel=\"noreferrer noopener\">Collecting your Faecal Calprotectin sample<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Crohn\u2019s and Colitis UK have also produced this video for patients: <a href=\"https:\/\/www.youtube.com\/watch?v=qLFP4T_Uty4\" target=\"_blank\" rel=\"noreferrer noopener\">The What\u2019s Up With My Gut Patient Toolkit<\/a> \u2013 some patients may find it helpful, but they should be advised that how assessment, investigation and referrals work in NHS Lothian are based on local policies and so can differ from national guidance.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Referrers in Primary Care may find this video produced by Crohn\u2019s and Colitis UK helpful, though should remember that there are differences between national pathways and local referral routes \/ pathways (e.g. FIT testing being different in NHS Lothian).<br><a href=\"https:\/\/www.youtube.com\/watch?v=OBLKYLrrokE\" target=\"_blank\" rel=\"noreferrer noopener\">Primary Care Diagnostic Pathway for Lower Gastrointestinal Symptoms &#8211; A Step By Step Guide<\/a><br>(Video endorsed by RCGP and RCN)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Referrers in Primary Care may find this video produced by Crohn\u2019s and Colitis UK (with RCGP and RCN) helpful, though it should remember that there are differences between national pathways and local referral routes \/ pathways. This video gives a summary of how the pathway was created.<br><a href=\"https:\/\/www.youtube.com\/watch?v=uz3w8Gj0aaQ\" target=\"_blank\" rel=\"noreferrer noopener\">Primary Care Diagnostic Pathway for Lower Gastrointestinal Symptoms: Creation of the pathway<\/a><br>(Video endorsed by RCGP and RCN)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Information on the national pathways (UK) can be found here: <a href=\"https:\/\/www.whatsupwithmygut.org.uk\/healthcare\" target=\"_blank\" rel=\"noreferrer noopener\">What&#8217;s Up With My Gut &#8211; resources for Healthcare Professionals<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Information on the national pathways (Scotland) can be found here: <a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/gastroenterology-pathways\/lower-gastrointestinal-symptoms-not-for-acutely-unwell-symptoms\/\" target=\"_blank\" rel=\"noreferrer noopener\">Lower gastrointestinal symptoms (not for acutely unwell symptoms) | Right Decisions<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The following <strong>Educational Resources<\/strong> may also be helpful:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.crohnsandcolitis.org.uk\/our-work\/healthcare-professionals\/resources-for-healthcare-professionals\/assessing-lower-gi-symptoms-in-primary-care\" target=\"_blank\" rel=\"noreferrer noopener\">Assessing lower-GI symptoms in primary care<\/a>: Educational resource introducing the national Primary Care Diagnostic Pathway for Lower Gastrointestinal symptoms. Local GP and Clinical Lead Dr Jane Marshall contributed to its development via her role as Clinical Champion for the Pathway<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.nbmedical.com\/clinics\/hot-topics-lower-gi-disease-clinic-2024-09-17\" target=\"_blank\" rel=\"noreferrer noopener\">Hot Topics Lower GI Disease Clinic | NB Medical<\/a>: A free interactive webinar on Lower GI Disease.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/education\/reftalks\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/refhelp\/education\/reftalks\/<\/a>: Scroll down the page to find a link to the 2024 RefTalk on Inflammatory Bowel Disease from WGH Consultant Dr Blackwell<\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>JB, RC, SD, FD &ndash; 17-8-26<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[194,195],"class_list":["post-3693","page","type-page","status-publish","hentry","category-gastrointestinal","category-lowergysymptoms"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/gastrointestinal\/\" rel=\"tag\">Gastrointestinal<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/gastrointestinal\/lowergysymptoms\/\" rel=\"tag\">Lower GI Symptoms<\/a>","rttpg_excerpt":"JB, RC, SD, FD &ndash; 17-8-26","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3693","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3693"}],"version-history":[{"count":2,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3693\/revisions"}],"predecessor-version":[{"id":29531,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3693\/revisions\/29531"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3693"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3693"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}