Persistent Abdominal Pain in Patients with Inactive Inflammatory Bowel Disease: A Clinical Conundrum

Area of Science:

• Gastroenterology
• Neurogastroenterology
• Immunology

Background:

• Inflammatory bowel disease (IBD) can disrupt gut homeostasis, leading to persistent abdominal symptoms even after active inflammation resolves.
• A significant percentage of IBD patients report symptoms similar to irritable bowel syndrome (IBS) during remission.

Purpose of the Study:

• To review and critically examine the literature on persistent abdominal pain in IBD remission.
• To explore the multifactorial pathophysiology underlying these symptoms.
• To highlight the need for a comprehensive diagnostic and treatment approach.

Main Methods:

• Literature review and critical examination of relevant studies.

Main Results:

• Persistent symptoms significantly impair quality of life and are often disabling.
• Identifying an underlying cause for these symptoms can be challenging.

Conclusions:

• Emerging evidence points to complex interactions including visceral hypersensitivity, enteric nervous system alterations, central sensitization, gut-brain axis dysregulation, and psychosocial factors.
• These factors contribute to pain in IBD remission, rather than ongoing mucosal inflammation.
• A comprehensive, biopsychosocial approach is crucial for diagnosis and treatment.