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Recent advances in clinical practice
Recent advances in clinical practice: mastering the challenge—managing IBS symptoms in IBD
  1. Judith Wellens1,2,
  2. João Sabino1,2,
  3. Tim Vanuytsel1,2,
  4. Jan Tack1,2,
  5. Séverine Vermeire1,2
  1. 1Gastroenterology and Hepatology, KU Leuven University Hospitals Leuven Gasthuisberg Campus Hospital Pharmacy, Leuven, Belgium
  2. 2Chronic Diseases, Metabolism and Ageing, Translational Research in GastroIntestinal Disorders, KU Leuven, Leuven, Belgium
  1. Correspondence to Professor Séverine Vermeire; severine.vermeire{at}uzleuven.be

Abstract

Many patients with IBD report persisting symptoms, despite resolution of the inflammatory process. Although by definition, a diagnosis of IBS cannot be made, the prevalence of ‘IBS in IBD’ surpasses the rate of IBS in the global population by fivefold. Because IBS-like symptoms are associated with a decreased quality of life and increased healthcare utilisation in IBD, diagnosis and treatment are necessary. In this review, we summarise the current knowledge on IBS-like symptoms in IBD. A pathophysiological common ground is present, which includes genetic susceptibility, environmental triggers, gut microbial dysbiosis, increased intestinal permeability, visceral hypersensitivity and involvement of brain–gut interaction. When symptoms persist after resolution of inflammation, other GI diseases should be excluded based on the chief complaint, considering any possible psychological co-morbidity early in the diagnostic work-up. Subsequent treatment should be initiated that is evidence-based and often multimodal, including classical and non-classical pharmacological agents as well as lifestyle and microbiota-based approaches, spanning the breadth of the gut, brain and its interaction. Treatment goals in this substantial part of the IBD population should be adapted to not only focus on treating the inflammation but taking care of the patient.

  • IBD
  • INFLAMMATORY BOWEL DISEASE
  • IRRITABLE BOWEL SYNDROME
  • BRAIN/GUT INTERACTION

https://doi.org/10.1136/gutjnl-2024-333565

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    Footnotes

    • JT and SV are joint senior authors.

    • X @JudithWellens, @joaoPGsabino

    • Contributors All authors conceived the concepts of the manuscript. JW wrote the first draft of the manuscript. JS, TV, JT and SV critically revised the manuscript. All authors approved the final version of the manuscript. SV is the guarantor of the article.

    • Funding JW was supported by the Research Foundation Flanders (FWO), Belgium, by a PhD Fellowship strategic basic research (SB) grant (1S06023N); Fonds Wetenschappelijk Onderzoek, and by the Belgian Inflammatory Bowel Disease Research and Development Grant 2023. JS and TV are supported by a senior clinical researcher fellowship from the Research Foundation Flanders (FWO).

    • Competing interests JW has no conflict of interest to disclose; JS reports speaker’s fees from Pfizer, Abbvie, Ferring, Falk, Takeda, Janssen, Fresenius, and Galapagos; consultancy fees from Janssen, Ferring, Fresenius, Abbvie, Galapagos, Celltrion, Pharmacosmos, and Pharmanovia; and research support from Galapagos and Viatri; TV has received lecturing fees from Abbott, Baxter, Biocodex, Dr Falk Pharma, Fresenius Kabi, Ipsen, Menarini, Microbiotica, MyHealth, Remedus, Schwabe, Takeda, Truvion. TV has served as a consultant for Baxter, Biocodex, BMS, Dr Falk Pharma, EcoR1, Hamni Pharm, Ipsen, Norgine, NorthSea Therapeutics, PSI, Takeda, Truvion, VectivBio, Zealand Pharma. TV has received research grants from Danone, Dr Falk Pharma, MyHealth, Takeda, VectivBio; JT has given Scientific advice to Aclipse, Adare, AlfaSigma, Clasado, Danone, Falk, FitForMe, Ironwood, Kyowa Kirin, Menarini, Promed, Ricordati, Takeda, Truvion, Tsumura, Zealand Pharmaceuticals, Zeria; has received research support from Biohit, Kiowa Kirin, ProMed, Sofar, Takeda and Tsumura and has served on the Speaker bureau for Abbott, Bio-Codex, Falk, Mayoly, Menarini, ProMed, Reckitt-Benckiser, Schwabe, Takeda and Truvion Pharmaceuticals; SV received financial support for research from AbbVie, J&J, Pfizer, Takeda and Galapagos and receives speakers’ and/or consultancy fees from AbbVie, Abivax, AbolerIS Pharma, AgomAb, Alimentiv, Arena Pharmaceuticals, Astra Zeneca, BMS, Boehringer Ingelheim, Celgene, Cytoki Pharma, Dr Falk Pharma, Ferring, Galapagos, Genentech-Roche, Gilead, GSK, Hospira, Imidomics, Janssen, J&J, Lilly, Materia Prima, Mestag Therapeutics, MiroBio, Morphic, MrM Health, Mundipharma, MSD, Pfizer, Prodigest, Progenity, Prometheus, Robarts Clinical Trials, Surrozen, Takeda, Theravance, Tillots Pharma AG, VectivBio, Ventyx, Zealand Pharma.

    • Provenance and peer review Not commissioned; externally peer reviewed.