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

Gastrointestinal tract inflammation may cause deep alterations of the gut homeostasis, even after the acute phase is resolved. Indeed, there is at present substantial evidence that a considerable percentage of patients with inactive inflammatory bowel disease may experience persistent abdominal symptoms (often resembling those of irritable bowel syndrome) long after the intestinal inflammatory flares had successfully treated and resolved.

The pertinent literature on this topic was reviewed and critically examined.

Persistent symptoms can be disabling and significantly impair the quality of life, particularly because it is often difficult or impossible to individuate an underlying cause.

Emerging evidence suggests that such pain may result from complex interactions involving visceral hypersensitivity, alterations in the enteric nervous system, central sensitization, dysregulation of the gut-brain axis, and psychosocial factors, rather than ongoing mucosal inflammation. This review explores the multifactorial pathophysiology underlying persistent abdominal pain in inflammatory bowel disease remission and highlights the need for a comprehensive, biopsychosocial approach to diagnosis and treatment.