Managing IBS-Like Symptoms in Quiescent Inflammatory Bowel Disease: A Meta-Analysis of Randomized Trials

Persistent IBS-like symptoms affect up to one-third of patients with inflammatory bowel disease (IBD) in remission, representing a major unmet need not addressed by anti-inflammatory therapies. Despite increasing use of dietary and gut-brain-targeted strategies, their efficacy in this population remains uncertain. We performed meta-analysis of randomized controlled trials(RCTs) to quantify the therapeutic effects of these interventions.

We systematically searched PubMed/MEDLINE, Embase, CENTRAL, Scopus, and ClinicalTrials.gov through October 2025 for RCTs enrolling adults with quiescent IBD and IBS-like symptoms. Interventions were synthesized according to intervention class (dietary, behavioral, pharmacologic, and other), with symptom severity and quality-of-life outcomes analyzed separately within each class. Standardized mean differences (SMDs) were pooled using random-effects models with Hartung-Knapp adjustment. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE.

Thirteen RCTs (n = 688) were included. Dietary interventions demonstrated the largest pooled symptom benefit (SMD -1.33, 95% CI -4.42 to 1.77; I²=90%), although evidence was very low certainty because of heterogeneity and imprecision. Behavioral interventions showed a small treatment effect (SMD -0.36, 95% CI -0.82 to 0.10; I²=0%) with low-certainty evidence. Evidence for pharmacologic and other interventions was limited to isolated, small trials. Risk of bias was high in 53.8% of studies, driven primarily by lack of blinding and subjective endpoints.

Current evidence does not support a definitive benefit for any single intervention class in the management of IBS-like symptoms in quiescent IBD. Although dietary interventions demonstrated the largest point estimate for symptom improvement, the evidence remained highly uncertain because of imprecision and risk of bias. Larger, rigorously designed blinded trials using standardized endpoints are needed to define effective symptom-directed therapies.