Quality standard

Quality statement 3: Dietary management

Quality statement 3: Dietary management

Quality statement

Adults with irritable bowel syndrome are offered advice on further dietary management if their symptoms persist after they have followed general lifestyle and dietary advice.

Rationale

General lifestyle and dietary advice is important to empower people with irritable bowel syndrome to manage their condition and to improve their quality of life. However, when symptoms persist beyond a time agreed with their healthcare professional, specialist advice from a healthcare professional with expertise in dietary management can help people to manage persistent symptoms. This advice can be given in primary care by healthcare professionals with relevant expertise in dietary management or a referral may be made. This advice can also ensure that a person has an adequate nutritional intake when following food avoidance, restriction or exclusion diets.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that adults with irritable bowel syndrome are offered advice on further dietary management if their symptoms persist after they have followed general lifestyle and dietary advice.

Data source: Local data collection.

Process

Proportion of adults with irritable bowel syndrome who are offered advice on further dietary management if their symptoms persist after they have followed general lifestyle and dietary advice for an agreed time.

Numerator – the number in the denominator who receive advice on further dietary management.

Denominator – the number of adults with irritable bowel syndrome whose symptoms persist after they have followed general lifestyle and dietary advice for an agreed time.

Data source: Local data collection.

Outcomes

a) People with irritable bowel syndrome feel confident to manage their condition.

Data source: Local data collection.

b) Satisfaction with care received for irritable bowel syndrome.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (GP practices and dietetic services) ensure that adults with irritable bowel syndrome are offered advice on further dietary management from healthcare professionals with relevant expertise, if symptoms persist after following general lifestyle and dietary advice for an agreed time.

Healthcare professionals (such as GPs, and community and secondary care dietitians) ensure that adults with irritable bowel syndrome are offered advice on further dietary management, if symptoms persist after following general lifestyle and dietary advice for an agreed time. This advice can be given in primary care by healthcare professionals with relevant expertise in dietary management or a referral may be made.

Commissioners commission services in which people with irritable bowel syndrome are offered advice on further dietary management from healthcare professionals with relevant expertise, if symptoms persist after following general lifestyle and dietary advice for an agreed time.

Adults with irritable bowel syndrome are offered further dietary advice from a healthcare professional with expertise in dietary management if their symptoms have not improved enough after following general advice on diet and lifestyle for a period of time agreed with their healthcare professional.

Source guidance

Irritable bowel syndrome in adults: diagnosis and management. NICE guideline CG61 (2008, updated 2017), recommendation 1.2.1.8

Definitions of terms used in this quality statement

General lifestyle and dietary advice

This is designed to help to minimise the symptoms of irritable bowel syndrome and should include:

  • creating relaxation time

  • increasing activity levels

  • having regular meals and taking time to eat

  • avoiding missing meals or leaving long gaps between eating.

Other general lifestyle and dietary advice includes:

  • drinking at least 8 cups (approximately 2,000 ml) of fluid per day, especially water or other non‑caffeinated drinks (for example, herbal teas)

  • restricting caffeinated tea and coffee to 3 cups (approximately 750 ml) per day

  • reducing intake of alcohol and soft drinks

  • limiting fresh fruit to 3 portions per day (a portion should be approximately 80 g)

  • avoiding sorbitol, an artificial sweetener found in sugar‑free sweets (including chewing gum), drinks and in some diabetic and slimming products, if the person has diarrhoea

  • eating 30 g per day of fibre

  • adjusting the amount of fibre consumed by restricting or increasing certain foods.

[Adapted from NICE's guideline on irritable bowel syndrome in adults, recommendations 1.2.1.1 (key priority for implementation), 1.2.1.2, 1.2.1.3 and 1.2.1.4, and information for the public and expert opinion]

Further dietary management

There are specific types of diets which can be followed to help manage the symptoms of irritable bowel syndrome. Single food avoidance is the exclusion of 1 food from the diet if it is thought to cause symptoms. After an agreed time (usually between 2 and 4 weeks), the food can be reintroduced gradually to verify whether it causes or exacerbates the symptoms.

A restricted or exclusion diet is when 1 or more foods suspected to cause symptoms are completely excluded for an agreed time before structured reintroduction. These diets may improve the symptoms of irritable bowel syndrome and can include, for example, a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet. FODMAPs are a collection of carbohydrates that are poorly absorbed in the small bowel and pass into the large bowel where they are quickly broken down (fermented) by bacteria. This can cause bloating, wind, and discomfort or pain. FODMAPs can also draw water into the bowel, causing diarrhoea. [Adapted from NICE's guideline on irritable bowel syndrome in adults, recommendation 1.2.1.8 and information for the public and expert opinion]

Equality and diversity considerations

Healthcare professionals should take into consideration the communication needs of people with irritable bowel syndrome, including cognitive impairment, when discussing and providing information on dietary management. All information should be culturally appropriate.