Introduction

The rapidly emerging evidence base for the use of faecal immunochemical testing (FIT) in the investigation of possible colorectal malignancy has resulted in widespread use of FIT as a triage tool between primary and secondary care. This has caused some disruption to established investigation pathways for iron deficiency anaemia (IDA) and confusion regarding the role of FIT in planning any investigation, especially with regard to the upper gastrointestinal (UGI) tract. To provide some clarity, the British Society of Gastroenterology (BSG) commissioned a small group drawn from the guideline groups for both the BSG faecal immunochemical test (FIT)1 and iron deficiency anaemia (IDA)2 guidelines, the BSG endoscopy section and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to assess current evidence and produce guidelines.

These guidelines are additive to the two published guidelines and act as clarification. It does not replace them. For example, it is still recommended that coeliac serology should be requested in primary care prior to referral.

There is a variation of how the investigation of IDA is managed in different parts of the UK, including who oversees the referral process and how investigations are arranged. These guidelines should be adopted according to local processes and governance.

These BSG/ACPGBI guidelines represent a consensus of best practice based on the available evidence at the time of preparation. They may not apply in all situations and should be interpreted in the light of specific clinical situations and resource availability. Further controlled clinical studies may be needed to clarify aspects of these statements, and revision may be necessary as new data appear. Clinical considerations may justify a course of action at variance to these recommendations, but we suggest that reasons for this are documented in the medical record. BSG guidelines are intended to be an educational resource to provide information that may assist in providing care to patients. They are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring or discouraging any particular treatment.