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Consequently, there have been calls for the care of patients with IBS to be standardised, a process which aims to promote high-quality and high-value care. Making an early diagnosis, based on a clinical assessment of symptoms, while limiting use of investigations, are key tenets of this process. Exhaustive investigation to exclude all organic pathology is unnecessary, and may be counterproductive. Routine blood tests in suspected IBS have low yield, but are an acceptable part of routine practice. All patients should have coeliac serology tested, regardless of their predominant stool form. Patients with diarrhoea should have a faecal calprotectin measured, and should proceed to colonoscopy to exclude inflammatory bowel disease (IBD) if this is positive. Beyond this, the need for investigations should be made on a case-by-case basis, contingent on the reporting of known risk factors for organic pathology. Colonoscopy should be considered in any patient with alarm features for colorectal cancer, and in those whose clinical features are suggestive of microscopic colitis. A 23-seleno-25-homotaurocholic acid (SeHCAT) scan should be considered in patients with IBS-D, a third of whom may actually have bile acid diarrhoea. There is no role for routine hydrogen breath tests for lactose malabsorption or small intestinal bacterial overgrowth.<\/jats:p>","DOI":"10.1136\/flgastro-2019-101211","type":"journal-article","created":{"date-parts":[[2019,6,6]],"date-time":"2019-06-06T17:15:28Z","timestamp":1559841328000},"page":"140-147","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Rational investigations in irritable bowel syndrome"],"prefix":"10.1136","volume":"11","author":[{"given":"Christopher J","family":"Black","sequence":"first","affiliation":[{"name":"Leeds Gastroenterology Institute, St. James\"s University Hospital, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6371-4359","authenticated-orcid":false,"given":"Alexander C","family":"Ford","sequence":"additional","affiliation":[{"name":"Leeds Gastroenterology Institute, St. James\"s University Hospital, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,6,6]]},"reference":[{"key":"2025090709153243000_11.2.140.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2012.02.029"},{"key":"2025090709153243000_11.2.140.2","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.131"},{"key":"2025090709153243000_11.2.140.3","unstructured":"Mearin F , Lacy BE , Chang L , et al . 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