IBS-like symptoms in inflammatory bowel diseases: clinical necessity or a terminological compromise?
https://doi.org/10.51793/OS.2026.29.5.004
Abstract
Background. Despite the availability of effective therapeutic strategies aimed at inducing and maintaining remission in inflammatory bowel disease, a subset of patients continues to experience persistent gastrointestinal symptoms, including recurrent abdominal pain and alterations in stool frequency and/or consistency. These manifestations are often interpreted as resembling symptoms of irritable bowel syndrome (IBS). Given the heterogeneity of potential etiologies underlying gastrointestinal disturbances and the absence of validated diagnostic criteria for this specific patient population, the use of the term "IBS-like symptoms" in the context of inflammatory bowel disease remains controversial. Persistent gastrointestinal complaints, and in some cases systemic manifestations, may be attributable to a broad spectrum of etiological factors. These include small intestinal bacterial overgrowth, bile acid malabsorption, carbohydrate (oligo- and monosaccharide) malabsorption, exocrine pancreatic insufficiency, gluten-related disorders, eosinophilic gastrointestinal diseases, mast cell activation syndrome, as well as conditions not directly involving the gastrointestinal tract, such as endometriosis and postoperative adhesions.
Conclusion. In light of the above, the use of the term "IBS-like symptoms" appears justified only in patients with inflammatory bowel disease who have achieved histological remission and in whom persistent gastrointestinal symptoms are attributable to disorders of the gut-brain axis. The application of this term should be reserved for cases in which alternative causes capable of explaining the clinical manifestations – both gastrointestinal and extraintestinal – have been carefully excluded.
About the Authors
I. G. Bakulin
I. I. Mechnikov Northwestern State Medical University
Russian Federation
Russian Federation
Igor G. Bakulin, Dr. of Sci. (Med.), Professor, Chief Non-staff Specialist in Internal Medicine of the Ministry of Health of the Russian Federation for the North-Western Federal District, Chief Nonstaff Gastroenterologist of the Leningrad Region, Director of the Institute of Therapy, Head of the Department of Propedeutics of Internal Diseases, Gastroenterology and Dietology named after S. M. Ryss,
47 Piskarevsky ave., Saint Petersburg, 195067
Yu. A. Akishina
I. I. Mechnikov Northwestern State Medical University
Russian Federation
Russian Federation
Yulia A. Akishina, Resident of the Department of Propedeutics of Internal Diseases, Gastroenterology and Dietology named after S. M. Ryss,
47 Piskarevsky ave., Saint Petersburg, 195067
References
1. Lim J., Rezaie A. Irritable bowel syndrome-like symptoms in quiescent inflammatory bowel disease: a practical approach to diagnosis and treatment of organic causes. Dig Dis Sci. 2023; 68 (11): 4081-4097. DOI: 10.1007/s10620-023-08095-w.
2. Abdalla M. I., Sandler R. S., et al. Prevalence and impact of inflammatory bowel disease-irritable bowel syndrome on patient-reported outcomes in CCFA partners. Inflamm Bowel Dis. 2017; 23: 325-331. DOI: 10.1097/MIB.0000000000001017.
3. Ford A. C., Lacy B. E., Talley N. J. Irritable bowel syndrome. N Engl J Med. 2017; 376 (26): 2566-2578.
4. Aliu A., Bosch D. H. C. A., Keszthelyi D., et al. A practical approach to persistent gastrointestinal symptoms in inflammatory bowel disease in remission. Aliment Pharmacol Ther. 2024; 59 (12): 1470-1488. DOI: 10.1111/apt.17988.
5. Kraimi N., Ross T., Pujo J., et al. The gut microbiome in disorders of gut-brain interaction. Gut Microbes. 2024; 16 (1): 2360233. DOI: 10.1080/19490976.2024.2360233.
6. Drossman D. A., Hasler W. L. Rome IV – functional GI disorders: disorders of gut-brain interaction. Gastroenterology. 2016; 150 (6): 1257-1261. DOI: 10.1053/j.gastro.2016.03.035.
7. Drossman D. A. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology. 2016; 150 (6): 1262-1279.e2. DOI: 10.1053/j.gastro.2016.02.032.
8. Mayer E. A., Ryu H. J., Bhatt R. R. The neurobiology of irritable bowel syndrome. Mol Psychiatry. 2023; 28 (4): 1451-1465. DOI: 10.1038/s41380-023-01972-w.
9. Fairbrass K. M., Costantino S. J., et al. Prevalence of irritable bowel syndrome-type symptoms in patients with inflammatory bowel disease in remission: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020; 5 (12): 1053-1062. DOI: 10.1016/S2468-1253(20)30300-9.
10. Turner D., Ricciuto A., Lewis A., et al. STRIDE-II: selecting therapeutic targets in inflammatory bowel disease. Gastroenterology. 2021; 160 (5): 1570-1583. DOI: 10.1053/j.gastro.2020.12.031.
11. Oka P., Parr H., Barberio B., et al. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020; 5 (10): 908- 917. DOI: 10.1016/S2468-1253(20)30217-X.
12. Barratt S. M., Leeds J. S., Robinson K., et al. Prodromal irritable bowel syndrome and delay in diagnosis of Crohn’s disease. Dig Dis Sci. 2011; 56: 3270-3275.
13. Fukuba N., Ishihara S., Tada Y., et al. Prevalence of irritable bowel syndrome-like symptoms in ulcerative colitis patients in remission. Scand J Gastroenterol. 2014; 49: 674-680.
14. Hoekman D. R., Zeevenhooven J., D’Haens G. R., et al. The prevalence of irritable bowel syndrometype symptoms in inflammatory bowel disease patients in remission. Eur J Gastroenterol Hepatol. 2017; 29: 1086-1090.
15. Henriksen M., Høivik M. L., JelsnessJørgensen L. P., et al. Irritable bowel-like symptoms in ulcerative colitis in deep remission. J Crohns Colitis. 2018; 12: 389-393.
16. Perera L. P., Radigan M., Guilday C., et al. IBS symptoms in quiescent inflammatory bowel disease and anxiety/depression. Dig Dis Sci. 2019; 64: 1923-1928.
17. Nigam G. B., Limdi J. K., Hamdy S., et al. Rome IV functional colorectal disorders in ulcerative colitis. Gut. 2019; 68: A203-A204.
18. Ozer M., Bengi G., Colak R., et al. IBS-like symptoms in inactive IBD using Rome IV criteria. Medicine (Baltimore). 2020; 99: e20067.
19. Vivinus-Nébot M., Frin-Mathy G., et al. Functional bowel symptoms in quiescent IBD: epithelial barrier disruption. Gut. 2014; 63: 744-752.
20. Tomita T., Kato Y., Takimoto M., et al. IBS-like symptoms in Japanese patients with inactive IBD. J Neurogastroenterol Motil. 2016; 22: 661-669.
21. Olsen B., Opheim R., Kristensen V.A., et al. Symptoms of IBS in remission from IBD: IBSEN III study. J Crohns Colitis. 2024; 18 (Suppl 1): i2055. DOI: 10.1093/ecco-jcc/jjad212.1277.
22. Colombel J. F., Shin A., Gibson P. R. AGA Clinical Practice Update on functional gastrointestinal symptoms in IBD. Clin Gastroenterol Hepatol. 2019; 17 (3): 380-390.e1. DOI: 10.1016/j.cgh.2018.08.001.
23. Barkun A. N., Love J., Gould M., et al. Bile acid malabsorption in chronic diarrhea. Can J Gastroenterol. 2013; 27 (11): 653-659.
24. Pimentel M., Saad R. J., Long M. D., et al. ACG clinical guideline: small intestinal bacterial overgrowth. Am J Gastroenterol. 2020; 115: 165-178. DOI: 10.14309/ajg.0000000000000501.
25. Lee J. M., Lee K. M., Chung Y. Y., et al. Clinical significance of glucose breath test in IBD. J Gastroenterol Hepatol. 2015; 30: 990-994. DOI: 10.1111/jgh.12908.
26. Wanzl J., Grohl K., Kafel A., et al. Impact of small intestinal bacterial overgrowth in patients with inflammatory bowel disease and other gastrointestinal disorders. J Clin Med. 2023; 12 (3): 935. DOI: 10.3390/jcm12030935.
27. Ghoshal U. C., Yadav A., Fatima B., et al. Small intestinal bacterial overgrowth in inflammatory bowel disease: a case-control study. Indian J Gastroenterol. 2022; 41: 96-103. DOI: 10.1007/s12664-021-01211-6.
28. Shah A., Morrison M., Burger D., et al. Prevalence of small intestinal bacterial overgrowth in inflammatory bowel disease: a systematic review and meta-analysis. Aliment Pharmacol Ther. 2019; 49 (6): 624-635. DOI: 10.1111/apt.15173.
29. Min Y. W., Rezaie A., Pimentel M. Bile acid and gut microbiota in irritable bowel syndrome. J Neurogastroenterol Motil. 2022; 28: 549-561. DOI: 10.5056/jnm22129.
30. Barrett J. S., Irving P. M., Shepherd S. J., et al. Comparison of fructose and lactose malabsorption across chronic intestinal disorders. Aliment Pharmacol Ther. 2009; 30: 165-174. DOI: 10.1111/j.1365-2036.2009.04018.x.
31. Ramos L. R., Sachar D. B., DiMaio C. J., et al. Inflammatory bowel disease and pancreatitis: a review. J Crohns Colitis. 2016; 10: 95-104. DOI: 10.1093/ecco-jcc/jjv153.
32. Sikkens E. C. M., Cahen D. L., Koch A. D., et al. Prevalence of fat-soluble vitamin deficiencies and decreased bone mass in chronic pancreatitis. Pancreatology. 2013; 13: 238-242.
33. Shintakuya R., Uemura K., Murakami Y., et al. Sarcopenia is associated with pancreatic exocrine insufficiency in pancreatic disease. Pancreatology. 2017; 17: 70-75.
34. De la Iglesia D., Vallejo-Senra N., López-López A., et al. Effect of pancreatic exocrine and endocrine insufficiency on cardiovascular events in chronic pancreatitis. Pancreatology. 2018; 18.
35. Maconi G., Dominici R., Molteni M., et al. Prevalence of pancreatic insufficiency in inflammatory bowel diseases assessed by fecal elastase-1. Dig Dis Sci. 2008; 53: 262-270. DOI: 10.1007/s10620-007-9852-y.
36. Pinto-Sanchez M. I., Seiler C. L., Santesso N., et al. Association between inflammatory bowel diseases and celiac disease: a systematic review and meta-analysis. Gastroenterology. 2020; 159 (3): 884-903.e31. DOI: 10.1053/j.gastro.2020.05.007.
37. Lazzano P., Fracas E., Nandi N., et al. Extraintestinal complications of celiac disease: treatment considerations. Expert Rev Gastroenterol Hepatol. 2024; 18 (12): 761-777. DOI: 10.1080/17474124.2024.2443053.
38. Cardenas-Torres F. I., Cabrera-Chavez F., Figueroa-Salcido O. G., et al. Non-celiac gluten sensitivity: an update. Medicina (Kaunas). 2021; 57: 526. DOI: 10.3390/medicina57060526.
39. Naik R. D., Seidner D. L., Adams D. W. Nutritional considerations in celiac disease and nonceliac gluten sensitivity. Gastroenterol Clin North Am. 2018; 47 (1): 139-154. DOI: 10.1016/j.gtc.2017.09.006.
40. Volta U., Caio G., De Giorgio R., et al. Non-celiac gluten sensitivity: a work-in-progress entity. Best Pract Res Clin Gastroenterol. 2015; 29: 477- 491. DOI: 10.1016/j.bpg.2015.04.006.
41. Di Sabatino A., Volta U., Salvatore C., et al. Small amounts of gluten in suspected nonceliac gluten sensitivity: a randomized trial. Clin Gastroenterol Hepatol. 2015; 13 (9): 1604-1612.e3.
42. Dellon E. S., Gonsalves N., Abonia J. P., et al. International consensus recommendations for eosinophilic gastrointestinal disease nomenclature. Clin Gastroenterol Hepatol. 2022; 20: 2474-2484.e3. DOI: 10.1016/j.cgh.2022.02.017.
43. Shoda T., Collins M. H., Rochman M., et al. Evaluating eosinophilic colitis as a unique disease using colonic molecular profiles. Gastroenterology. 2022; 162 (6): 1635-1649. DOI: 10.1053/j.gastro.2022.01.022
44. Walker M. M., Potter M., Talley N. J. Eosinophilic gastroenteritis and other eosinophilic gut diseases. Lancet Gastroenterol Hepatol. 2018; 3: 271-280. DOI: 10.1016/S2468-1253(18)30005-0.
45. Tozlu M., Cash B., Younes M., et al. Dilemma in post-IBD patients with IBS-D symptoms. Expert Rev Gastroenterol Hepatol. 2021; 15: 5-8. DOI: 10.1080/17474124.2021.1829469.
46. Pineton de Chambrun G., Gonzalez F., et al. Natural history of eosinophilic gastroenteritis. Clin Gastroenterol Hepatol. 2011; 9 (11): 950-956. e1. DOI: 10.1016/j.cgh.2011.07.017.
47. Abou Rached A., El Hajj W. Eosinophilic gastroenteritis: approach to diagnosis and management. World J Gastrointest Pharmacol Ther. 2016; 7 (4): 513-523. DOI: 10.4292/wjgpt.v7.i4.513.
48. Weiler C. R., Austen K. F., Akin C., et al. Mast cell activation syndrome diagnosis and management. J Allergy Clin Immunol. 2019; 144 (4): 883-896.
49. Boeckxstaens G. Mast cells and inflammatory bowel disease. Curr Opin Pharmacol. 2015; 25: 45-49. DOI: 10.1016/j.coph.2015.11.005.
50. Fan L., Wong M., Fan X. S., et al. Intramucosal mast cells in IBS vs IBD in remission. J Clin Gastroenterol. 2021; 55: 244-249. DOI: 10.1097/MCG.0000000000001394.
51. Gelbmann C. M., Mestermann S., Gross V., et al. Strictures in Crohn's disease are characterized by accumulation of mast cells. Gut. 1999; 45: 210-217. DOI: 10.1136/gut.45.2.210.
52. Afrin L. B., Ackerley M. B., Bluestein L. S., et al. Diagnosis of mast cell activation syndrome: a global consensus-2. Diagnosis (Berl). 2020; 8 (2): 137-152. DOI: 10.1515/dx-2020-0005.
53. Beckers A. B., Keszthelyi D., Fikree A., et al. Gastrointestinal disorders in joint hypermobility syndrome/Ehlers-Danlos syndrome. Neurogastroenterol Motil. 2017; 29: e13013. DOI: 10.1111/nmo.13013.
54. DiBaise J. K., Harris L. A., Goodman B. Postural tachycardia syndrome and the GI tract. Am J Gastroenterol. 2018; 113: 1458-1467. DOI: 10.1038/s41395-018-0215-4.
55. Yu V., McHenry N., Proctor S., et al. Endometriosis for gastroenterologists. Dig Dis Sci. 2023. DOI: 10.1007/s10620-022-07674-7.
56. Chiaffarino F., Cipriani S., Ricci E., et al. Endometriosis and inflammatory bowel disease: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2020; 252: 246-251. DOI: 10.1016/j.ejogrb.2020.06.051.
57. Young S., Burns M. K., DiFrancesco L., et al. Diagnostic and treatment guidelines for gastrointestinal endometriosis. J Turk Ger Gynecol Assoc. 2017; 18: 200-209. DOI: 10.4274/jtgga.2017.0143.
58. Veeraswamy A., Lewis M., Mann A., et al. Extragenital endometriosis. Clin Obstet Gynecol. 2010; 53: 449-466.
59. Parker M. C., Wilson M. S., Menzies D., et al. The SCAR-3 study: adhesion-related readmission risk. Colorectal Dis. 2005; 7: 551-558. DOI: 10.1111/j.1463-1318.2005.00857.x.
60. Moris D., Chakedis J., Rahnemai-Azar A. A., et al. Postoperative abdominal adhesions. J Gastrointest Surg. 2017; 21 (10): 1713-1722. DOI: 10.1007/s11605-017-3488-9.
61. Rezaie A., Gu P., Kaplan G. G., et al. Dyssynergic defecation in inflammatory bowel disease. Inflamm Bowel Dis. 2018; 24 (5): 1065-1073. DOI: 10.1093/ibd/izx095.
62. Quinn K. P., Tse C. S., Lightner A. L., et al. Nonrelaxing pelvic floor dysfunction after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol. 2017; 15: 1242-1247. DOI: 10.1016/j.cgh.2017.02.024.
63. Coffin B., Duboc H. Persistent abdominal pain beyond irritable bowel syndrome. Aliment Pharmacol Ther. 2022; 56 (3): 419-435. DOI: 10.1111/apt.17064.
64. Farmer A. D., Gallagher J., Bruckner-Holt C., et al. Narcotic bowel syndrome. Lancet Gastroenterol Hepatol. 2017; 2 (5): 361-368. DOI: 10.1016/ S2468-1253(16)30217-5.
65. Jharap B., Seinen M. L., de Boer N. K., et al. Thiopurine therapy in inflammatory bowel disease. Inflamm Bowel Dis. 2010; 16 (9): 1541-1549. DOI: 10.1002/ibd.21221.
66. Philpott H. L., Nandurkar S., Lubel J., et al. Druginduced gastrointestinal disorders. Postgrad Med J. 2014; 90 (1065): 411-419. DOI: 10.1136/postgradmedj-2013-100316
67. Jain V., Pitchumoni C. S. Gastrointestinal side effects of prescription medications in older adults. J Clin Gastroenterol. 2009; 43 (2): 103-110. DOI: 10.1097/MCG.0b013e31818f9227.
68. Shian B., Larson S. T. Abdominal wall pain: evaluation and treatment. Am Fam Physician. 2018; 98 (7): 429-436.
69. Jagt J. Z., Pothof C. D., Buiter H. J. C., et al. Adverse events of thiopurine therapy in pediatric IBD. Dig Dis Sci. 2022; 67 (1): 241-251. DOI: 10.1007/s10620-021-06836-3.
70. Moran G. W., Dubeau M. F., Kaplan G. G., et al. Clinical predictors of thiopurine-related adverse events in Crohn's disease. World J Gastroenterol. 2015; 21 (25): 7795-7804. DOI: 10.3748/wjg.v21.i25.7795.
71. Zudeh G., Franca R., Stocco G., et al. Biomarkers for gastrointestinal adverse events related to thiopurine therapy. World J Gastroenterol. 2021; 27 (38): 6348-6356. DOI: 10.3748/wjg.v27.i38.6348.
72. Groeger D., O’Mahony L., Murphy E. F., Bourke J. F., Dinan T. G., Kiely B., et al. Bifidobacterium infantis 35624 modulates host inflammatory processes beyond the gut. Gut Microbes. 2013; 4 (4): 325-339. DOI: 10.4161/gmic.25487.
73. Maslennikov R., Gosteeva E., Ananeva V., Korshunova L., Kravtsowa A., Poluektova E., et al. Strain-specific systematic review with meta-analysis of probiotics efficacy in the treatment of irritable bowel syndrome. J Clin Med. 2026; 15: 1152. DOI: 10.3390/jcm15031152.
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Bakulin I.G., Akishina Yu.A. IBS-like symptoms in inflammatory bowel diseases: clinical necessity or a terminological compromise? Lechaschi Vrach. 2026;(5):34-40. (In Russ.) https://doi.org/10.51793/OS.2026.29.5.004
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