Irritable bowel syndrome in patients with inflammatory bowel disease
- Richard P MacDermott, MD
Richard P MacDermott, MD
- Emeritus Professor of Medicine, Division of Gastroenterology
- The Albany Medical College
A challenge in the care of patients with chronic inflammatory bowel disease (IBD) is differentiating gastrointestinal (GI) tract symptoms due to irritable bowel syndrome (IBS) from those due to residual inflammation from IBD [1-5]. IBS symptoms are more prevalent in patients with chronic IBD compared to control groups; 39 percent versus 8 percent in one study . Coexistent IBS in the IBD patient can lead to significant impairment in quality of life, anxiety, and depression, as well as unhealthy coping strategies and increased use of health care resources [7-11]. Furthermore, it can also lead to the increased use of IBD medications, with their potential side effects. Therefore, it is important to be able to recognize IBS in patients with IBD and also to use treatment approaches that are both practical and effective.
This topic reviews the approach to recognizing symptoms of IBS in patients with IBD as well as their diagnosis and management. The clinical symptoms, diagnosis, and management of IBS in general are discussed separately. (See "Clinical manifestations and diagnosis of irritable bowel syndrome in adults" and "Treatment of irritable bowel syndrome in adults".)
The clinical manifestations of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) can overlap. However, there are some clinical characteristics that can help differentiate between them:
●Abdominal pain is increased in patients who have both IBS and IBD because the perception of pain can be increased due to hypersensitivity to painful stimuli. Abdominal pain due to IBS is often cramping, diffuse, and relieved by a bowel movement, while abdominal pain due to IBD is often constant, in a specific location, and not relieved by a bowel movement.
●Watery diarrhea is common in both IBS and active Crohn's disease. However, bloody diarrhea is consistent with active ulcerative colitis, and does not occur in IBS.
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- CLINICAL MANIFESTATIONS
- DIFFERENTIAL DIAGNOSIS
- Laboratory testing
- Stool studies
- Radiologic imaging
- Dietary modification
- - Exclusion of foods associated with diarrhea, bloating, and cramping
- - Food allergies
- - Diarrhea
- - Abdominal pain and cramping
- - Constipation
- - Psychiatric symptoms
- SUMMARY AND RECOMMENDATIONS