Irritable bowel syndrome in patients with quiescent inflammatory bowel disease. A review

Burgell R1, Asthana A, Gibson PR. Minerva Gastroenterol Dietol. 2015 Sep 30. [Epub ahead of print]
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1Department of Gastroenterology, Alfred Health and Monash University, Melbourne,Victoria, Australia - rebecca.burgell@monash.edu.


Ongoing troublesome bowel symptoms despite quiescent inflammatory disease are a frequent management challenge when caring for patients with Inflammatory Bowel Disease. Even when active disease has been excluded the prevalence of residual gastrointestinal symptoms is surprisingly high and the cause often obscure. The presence of a concurrent functional disorder such as irritable bowel syndrome is associated with worse quality of life, worse physical functioning, higher prevalence of anxiety and greater health care utilization. Potential aetiological mechanisms leading to the development of irritable bowel syndrome like symptoms include the development of visceral hypersensitivity following the original inflammatory insult, alteration in cortical processing, dysbiosis and residual subacute inflammation. Therapeutic options for managing irritable bowel syndrome in patients with inflammatory bowel disease includes dietary modification, interventions targeted at correction of visceral sensory dysfunction or cortical processing and modulation of the gut microbiota. As there are few studies specifically examining the treatment of irritable bowl syndrome in patients with inflammatory bowel disease, the majority of therapeutic interventions are extrapolated from the irritable bowel syndrome literature. Given the frequency of residual functional symptoms in irritable bowel syndrome, significantly more research is warranted in this field.

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