Irritable Bowel Syndrome in Inflammatory Bowel Disease Patients: Prevalence, Etiology, and Treatment

One in 4 patients with endoscopically confirmed quiescent inflammatory bowel disease (IBD) reports persistent gastrointestinal symptoms, which are often compatible with irritable bowel syndrome (IBS). The reporting of these IBS-type symptoms is associated with psychological comorbidity, impaired quality of life, and increased health care utilization. The brain-gut axis, which provides the link between the central nervous system and gastrointestinal tract, may facilitate these relationships. In IBS, dietary manipulation, gut-brain neuromodulators, and brain-gut behavioral therapies may have a beneficial effect on symptom reporting and quality of life. However, evidence supporting their use in patients reporting IBS-type symptoms specifically in IBD is lacking. Despite this, observational studies describing the relationship between mood and inflammatory activity highlight the role of the brain-gut axis in the pathophysiology of IBD. There remains a need for further carefully designed clinical trials of treatments targeting the brain-gut axis in IBD patients reporting IBS-type symptoms, who may be most likely to respond to these therapies. An integrated approach to management, combining treatments targeting inflammatory activity and brain-gut axis dysfunction, has the potential to improve the natural history of symptoms, psychological well-being, and quality of life in this select group of patients with IBD. This article will review the prevalence, impact, etiology, and treatment options for the management of patients with quiescent IBD who report IBS-type symptoms.