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1 SCOPE AND PURPOSE
1.1 Aims
These guidelines were compiled at the request of the Chairman of the Clinical Services Committee of the British Society of Gastroenterology. The committee's aim was to provide a guide for the assessment and management of adult patients with irritable bowel syndrome (IBS). These patients comprise such a large proportion of gastroenterology outpatients that their streamlined and effective management would have a favourable effect on any gastroenterology department's overall performance, and hence improve the management of all gastrointestinal diseases. There are many questions to be addressed (box 1).
These guidelines are designed to be applied to adults with IBS, though they are also likely to apply to most adolescents.
The guideline committee was chosen from members of the British Society of Gastroenterology, aiming to include individuals with a longstanding interest and expertise in the topics to be discussed. Members were chosen to be representative of the spectrum of individuals likely to see such patients, including general practitioners, gastroenterologists from district general hospitals and university hospitals, surgeons and clinical physiologists.
People who suffer from IBS and members of the United Kingdom based IBS Network were also shown this document and their comments have influenced the final version.
The guidelines are aimed primarily at consultant gastroenterologists and trainees in gastroenterology, together with general practitioners with a special interest in gastroenterology. A summary form of this document is available with "when to refer" advice for use in primary care (see page 82) which is available online at the Journal website (http://gut.bmj.com/supplemental).
1.2 Development of guidelines
Members of the committee were allocated particular areas to produce review documents for. Literature searching included systematic searches using electronic databases such as Pubmed, EMBASE, MEDLINE, Web of Science, and Cochrane databases and extensive personal reference databases. Citation of the literature is however selective and in particular many low quality studies were discounted. Special attention was paid to high quality studies which used established methodology and substantial patient numbers with clearly defined entry criteria. For trials of treatment, randomisation and placebo control were considered essential. These documents were collated and edited by the Chairman, and the resulting document discussed at a one day face to face meeting. Detailed internal review by members of the committee was followed...