When should I consider referring a patient with Inflammatory Bowel Disease to a specialist for further evaluation?

Consider referring a patient with inflammatory bowel disease (IBD) to a specialist for further evaluation in the following situations:

• If Crohn's disease or ulcerative colitis is suspected and the patient is systemically unwell with severe symptoms such as bloody diarrhoea, fever, tachycardia, or hypotension, arrange emergency hospital admission or urgent specialist referral if admission is not indicated NICE CKS,NICE CKS.
• For confirmation of diagnosis and initiation of specialist treatment, arrange an urgent referral to a gastroenterologist (adult) or paediatric gastroenterologist (child) when IBD is suspected but not yet confirmed NICE CKS,NICE CKS.
• If there are suspected extra-intestinal manifestations of IBD that cannot be managed in primary care, refer to the appropriate specialist (e.g., rheumatology, dermatology, ophthalmology) NICE CKS,NICE CKS.
• If the diagnosis remains uncertain after primary care assessment and infection and other common causes have been excluded, consider referral for further evaluation NICE CKS.
• For ongoing management, patients with confirmed IBD should be reviewed regularly in primary care with the frequency depending on clinical judgement and specialist follow-up, but initial specialist assessment should occur within four weeks of referral NICE CKS.

Additional considerations: Patients with IBD whose symptoms started 10 years ago should be offered colonoscopic surveillance to assess colorectal cancer risk, which may require specialist involvement NICE CG118.