Supporting people with lower gastrointestinal symptoms: recognising and managing inflammatory bowel disease

Lower gastrointestinal symptoms are frequently encountered in primary care and can be caused by a range of conditions, including functional bowel disorders, infection, inflammatory bowel disease or colorectal cancer. For primary care nurses and teams, safe assessment depends on recognising red-flag features, taking a structured history, undertaking focused examination and selecting appropriate first-line investigations. This article outlines a practical, pathway-based approach to managing lower gastrointestinal symptoms, with particular emphasis on identifying possible inflammatory bowel disease in primary care settings. It discusses the role of faecal immunochemical testing when colorectal cancer is a concern and faecal calprotectin when inflammatory disease is suspected, alongside other investigations such as blood tests and stool microbiology. Common differential diagnoses, including coeliac disease, microscopic colitis, bile acid diarrhoea, diverticular disease and irritable bowel syndrome, are also reviewed. The authors emphasise that timely referral, coordinated follow up and explicit safety netting are essential to support earlier diagnosis and safer care in patients with lower gastrointestinal symptoms.