When should I consider referring a patient with functional gastrointestinal disorders to a gastroenterologist for further evaluation?

Consider referring a patient with functional gastrointestinal disorders (such as IBS) to a gastroenterologist for further evaluation if any of the following occur:

• Presence of 'red flag' symptoms or signs suggestive of serious underlying pathology, including symptoms or signs of cancer or inflammatory bowel disease, as per NICE suspected cancer guidelines and inflammatory markers assessment ¹.
• Failure to respond to pharmacological treatments after 12 months, with continuing symptoms consistent with refractory IBS, where psychological interventions may be considered and specialist input is warranted ¹.
• Emergence of new or worsening 'red flag' symptoms during follow-up or management, prompting further investigation or referral ¹.

In children and young people with gastro-oesophageal reflux symptoms, referral to a paediatric gastroenterologist or appropriate specialist should be considered if there are complications, persistent symptoms beyond infancy, or presence of 'red flags' such as projectile vomiting, bile-stained vomiting, haematemesis, feeding difficulties, faltering growth, or marked distress ².