The overlap between IBS and IBD: what is it and what does it mean?

Area of Science:

• Gastroenterology
• Internal Medicine
• Clinical Research

Background:

• Irritable bowel syndrome (IBS)-like symptoms are frequently reported in patients with inflammatory bowel disease (IBD) during clinical remission.
• The etiology of these symptoms is debated, with some attributing them to IBS triggers like anxiety, while others suggest underlying sub-clinical IBD activity.

Purpose of the Study:

• To propose a unifying model for understanding IBS-type symptoms in IBD patients in remission.
• To introduce the concept of "irritable inflammatory bowel syndrome" (IIBS) to describe this unique clinical presentation.
• To provide a framework for differentiating IIBS from both IBS and active IBD.

Main Methods:

• Review of existing literature on IBS symptoms in IBD patients.
• Analysis of Rome III criteria for IBS and findings of subtle inflammation in IBD patients.
• Development of a conceptual model to integrate current knowledge.

Main Results:

• IBS-like symptoms in IBD remission patients share features with both IBS (Rome III criteria, anxiety correlation) and IBD (subtle inflammatory changes).
• A clear distinction between superimposed IBS and sub-clinical IBD is often challenging.
• The proposed unifying model suggests a distinct entity requiring specific consideration.

Conclusions:

• The term "irritable inflammatory bowel syndrome" (IIBS) is proposed for IBS-type symptoms in IBD remission patients.
• IIBS acknowledges the unique presentation and potential dual etiology, distinct from primary IBS or active IBD.
• This conceptualization aims to improve understanding and guide targeted therapeutic strategies for improved patient outcomes.