IBD

Diarrhoea symptoms in inflammatory bowel disease

Dr Jordi Guardiola

Head of the Department of Digestive Diseases, Bellvitge University Hospital, Barcelona, Spain

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We do not know exactly why patients with inflammatory bowel disease (IBD) have clinical symptoms. There is no correlation between endoscopic lesions and the clinical manifestations assessed by the Crohn’s disease activity index.¹

This lack of correlation has been confirmed in a post hoc analysis of patients in the Study of Biologic and Immunomodulator Naive Patients in Crohn’s Disease trial. The study analysed the probability of presenting intestinal lesions in patients with symptoms. In all cases, a positive predictive value of 65% was observed which indicated that symptoms have limited use in determining whether a patient has endoscopic activity.² It has therefore been postulated that patients with IBD could have post-inflammatory irritable bowel syndrome (IBS). In fact, a number of systematic reviews have indicated that more than a third of patients in remission from inflammatory disease have symptoms that meet the Rome criteria.³

A study was published in 1994 that primarily investigated patients with Crohn’s disease with long-standing diarrhoea who did not respond to conventional treatment. The study observed that all patients with a history of ileal resection presented with bile acid diarrhoea (BAD), as well as a third of the patients without resection.⁴ There is a need to confirm the presence of BAD in symptomatic patients with Crohn’s disease in whom there is no clear evidence of inflammatory activity. Treatment success with bile acid binders will depend, in part, on the patient understanding their disease and treatment, and on the conviction of the physician in prescribing the therapy.

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