Dilemma in post-IBD patients with IBS-D symptoms; A 2020 overview

Expert Rev Gastroenterol Hepatol. 2020 Sep 29. doi: 10.1080/17474124.2021.1829469.Online ahead of print.

Mukaddes Tozlu 1, Brooks Cash 1, Atilla Ertan 1


Author information

  • 1University of Texas McGovern Medical School , Gastroenterology, Hepatology and Nutrition Section; Ertan Digestive Disease Center, Houston, Texas.


Introduction: Inflammatory bowel disease (IBD) patients in apparent clinical remission who present with irritable bowel syndrome (IBS)-like symptoms pose a diagnostic and therapeutic dilemma that is called post-IBD IBS. When associated with a diarrheal IBS presentation, this clinical syndrome is known as post-IBS IBS-D.

Areas covered: We review and describe the literature regarding the clinical overlap of IBD and IBS. We discuss prevalent theories regarding the pathophysiology of post-IBD IBS-D and whether this presentation represents coincident inherent IBS-D, IBS-D triggered by IBD, or an even more subtle level of IBD activity that is unrecognized by available laboratory modalities. We also discuss observations that post IBD IBS-D patients harbor significantly increased colon mucosal eosinophils and appear to respond to a GI-hypoallergenic diet and budesonide therapy.

Expert opinion: The symptoms overlap between IBD and IBS complicates diagnosis and subsequent management of patients with post-IBD IBS-D. In addition to current theories regarding the pathophysiology of this condition such as alterations in mucosal inflammation, the microbiota, mucosal permeability, and gut-brain interactions. This new avenue of eosinophilic colopathy and therapy directed towards food-derived immune response in patients with post-IBD IBS-D deserves additional investigation.

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