Authors: Mohsin F. Butt, Mustafa H. Reghefaoui, Aaron Shailesh Benedict, Maiss Reghefaoui, Hussain Al-Jabir, Aneeqa Shaikh, Katarina Vojtekova, Gordon W. Moran, Maura Corsetti and Qasim Aziz
Journal: Journal of Clinical Medicine
Year: 2025
Volume: 15
Page number: 116
DOI: 10.3390/jcm15010116
Study at a Glance
- Study type: Narrative review
- Participants: Patients with quiescent inflammatory bowel disease experiencing irritable bowel syndrome-type symptoms
- Main topic: Mechanisms, diagnosis, and management of irritable bowel syndrome-type symptoms in patients with inactive inflammatory bowel disease
- Key themes: Biopsychosocial model, gut–brain interaction, residual inflammation, psychological comorbidities, dietary interventions, neuromodulators
Why was this study done?
Irritable bowel syndrome (IBS) is a disorder of the gut–brain interaction, characterised by recurrent abdominal pain associated with changes in stool frequency or form. Among patients with inflammatory bowel disease (IBD) in remission, defined as the absence of endoscopic evidence of active inflammation, around one in three experience IBS-type symptoms. These symptoms reduce quality of life and complicate clinical assessments by resembling other conditions such as small intestinal bacterial overgrowth or bile acid malabsorption.
Butt and colleagues conducted this review to bring together current understanding of why IBS-type symptoms occur in patients with IBD, how to distinguish these symptoms from active disease, and which treatments may be helpful.
How was the study performed?
The authors performed a narrative review, summarising published evidence on IBS-type symptoms in quiescent IBD. They examined research on underlying mechanisms, including residual inflammation, gut permeability changes, altered gut bacteria, increased gut sensitivity, nerve function, and psychological factors. The review explored symptom-focused diagnostic approaches whilst ruling out active inflammation, and summarised evidence on dietary, psychological, and pharmacological management.
What did the researchers find?
The authors identified several mechanisms contributing to IBS-type symptoms in people with inactive IBD: low-grade residual inflammation, increased gut lining permeability, gut bacteria imbalance, heightened gut sensitivity, and impaired psychosocial wellbeing. Ongoing immune activity or barrier disruption, even without visible inflammation on endoscopy, may explain persistent symptoms.
Diagnosis can be challenging because symptoms may resemble other IBD-linked conditions. The authors emphasised a positive, symptom-focused diagnostic approach whilst carefully excluding active inflammation using faecal calprotectin, a stool test measuring bowel inflammation, and endoscopy or imaging where appropriate.
Regarding treatment, evidence supports a biopsychosocial approach integrating biological, psychological, and social health aspects. Evidence from randomised controlled trials, a study where people are randomly assigned to treatment groups, supports the low-FODMAP diet, which restricts certain symptom-triggering carbohydrates, and brain–gut behavioural therapies such as cognitive behavioural therapy and hypnotherapy. Effective pharmacological treatments included antispasmodics, antidiarrheals, laxatives, and neuromodulators such as tricyclic antidepressants. Tricyclic antidepressants may be more effective for ulcerative colitis patients than for those with Crohn’s disease.
Psychological comorbidities, particularly depression and anxiety, are strongly associated with IBS-type symptoms in IBD, especially ulcerative colitis. Addressing psychological factors is therefore essential.
The authors noted limited evidence in some areas and that future studies should integrate better biomarkers and longitudinal follow-up to improve diagnostic accuracy and guide personalised treatment.
What did the authors conclude?
The authors concluded that IBS-type symptoms in quiescent IBD affect approximately one in three patients and reduce quality of life. These symptoms arise from complex interactions between functional and organic processes, including residual inflammation, altered gut barrier function, microbiota imbalance, increased sensitivity, and psychological factors.
They recommended a positive, symptom-focused diagnostic approach alongside careful exclusion of active inflammation. Management should follow a biopsychosocial approach using dietary interventions, psychological therapies, and pharmacological treatments tailored to individual symptom profiles and psychological state.
Future research should refine diagnostic tools, particularly incorporating sensitive biomarkers, and evaluate targeted treatments in randomised trials for this patient group. Understanding the IBS-IBD overlap is essential to reduce burdens on patients’ physical health, psychological wellbeing, and daily functioning.
Key Takeaways
- Approximately one in three patients with quiescent inflammatory bowel disease experience irritable bowel syndrome-type symptoms.
- These symptoms arise from a combination of residual inflammation, altered gut barrier function, microbiota imbalance, increased gut sensitivity, and psychological factors.
- A positive, symptom-focused diagnostic approach is recommended, with careful exclusion of active inflammation using tests such as faecal calprotectin and endoscopy.
- Management should integrate dietary strategies such as the low-FODMAP diet, brain–gut behavioural therapies, and pharmacological treatments including neuromodulators and antispasmodics.
- Psychological comorbidities, particularly depression and anxiety, are strongly associated with irritable bowel syndrome-type symptoms in inflammatory bowel disease and should be addressed as part of treatment.
This Scientific Publication Summary is an objective summary of the published study for personal and educational use. It does not constitute medical advice, endorsement of the intervention, or a recommendation to alter clinical practice.