Diagnosis and management of functional symptoms in inflammatory bowel disease in remission

Short summary

Patients with inflammatory bowel disease (IBD) frequently experience symptoms similar to irritable bowel syndrome (IBS) whilst in remission. Although in remission, IBD patients with IBS have an impaired quality of life and are more likely to experience anxiety or depression than their asymptomatic counterparts. IBD-IBS is likely to be secondary to other factors, such as increased epithelial permeability, colonic dysmobility and intestinal hypersensitivity.

IBS-type symptoms have been reported in approximately 33% of IBD patients in remission. However, prevalence data is variable because of varying definitions of remission, and heterogeneous diagnostic and exclusion criteria. It is as yet unclear why some patients remain asymptomatic while others experience IBS-like symptoms of functional origin.

It is not easy to define remission in IBD as it encompasses a range of criteria including the absence of symptoms and identification of intestinal mucosal healing. Endoscopy is the most reliable test to determine the remission status of the patient, but it is invasive and uncomfortable.

Rome III criteria are typically used to diagnose functional symptoms of IBS in IBD patients in remission. IBS is characterised by abdominal pain or discomfort associated with changes in the frequency or consistency of bowel movements. There are no agreed definitions that can diagnose IBS-like symptoms in quiescent IBD.

Treatment strategies for IBD patients with IBS are not well defined, and patients are usually treated with IBS treatments, including dietary changes, antidepressants, antispasmodics and probiotics. A step-by-step approach to devising treatment strategies is required to resolve inflammation and to address the symptoms that impair the quality of life and psychological well-being of these patients.

Job number: JB02445UK Date of Preparation: March 2023

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diagnosis management functional symptoms inflammatory bowel disease remission inflammatory bowel disease (ibd) irritable bowel syndrome (ibs) quality of life anxiety depression asymptomatic counterparts bd-ibs i epithelial permeability colonic dysmobility intestinal hypersensitivity