Several different conditions can lead to symptoms surrounding the gastrointestinal (GI) tract but two common conditions which may occur together are irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). For world IBD day this year, let's take a look at the overlap between IBS and IBD!
How can IBS and IBD be similar?
Those who may be experiencing IBS may see symptoms such as diarrhea, constipation, or mix, Invisible disease and nerve pain/ sensitivity. It is predominantly a small intestine disease, and breath tests & endoscopies are used to diagnose and monitor it. IBD on the other hand can physically be seen in tests, is genetically and environmentally driven, can occur in the small intestine or large intestine and uses stool tests & colonoscopies used to diagnose and monitor. Some important similarities between the two are feelings of abdominal discomfort, abdominal pain, gas, bloating, stool urgency, exacerbation by stress, and dysbiosis. Check out the chart below for a summarized version of how IBS and IBD are similar!
Can you experience IBS and IBD at the same time?
The potential causes, signs, and symptoms of IBS and IBD are similar, therefore making it difficult to distinguish between the two conditions without proper testing with a gastroenterologist. It is possible to experience IBS-like symptoms when diagnosed with IBD with no signs of active inflammation. It is proposed that one would not technically have IBS, but instead, these symptoms would be classified as IBS-type symptoms.(10)
It is common that after inflammatory events in the GI tract such as diverticulitis, and IBD go into remission, to see IBS develop.(11) Some reports show that 25.8% of patients with IBD in remission may experience IBS-type symptoms.(11,12) Research is ongoing regarding if IBS could be classified as a mild subset of IBD or on a similar spectrum of disease.(13)
Both conditions report links with the gut-brain axis, dysbiosis, and an impaired epithelial barrier.(13) As previously discussed, mood disorders like depression and anxiety are risk factors for IBS. In patients with an added IBD diagnosis, these conditions can induce an inflammatory response and increase gut permeability with stress.(11,13). Therefore, those with increased depression and anxiety reported increased IBS-type symptoms, further linking these two conditions.(11)
Dysbiosis is linked with numerous conditions with estimations of 72% of IBS patients and 73% of IBD patients compared to only 16% in healthy individuals.(13) Many researchers relate IBS-type symptoms in those with IBD in remission as related to underlying low-grade inflammation that may not be detected through traditional diagnostic methods.(14) More research is needed to develop this theory further.
In each case, when a patient has IBS, IBD, or IBS-type symptoms with IBD in remission, the goal is to increase the quality of food, and fiber when possible while managing stress to improve outcomes like dysbiosis, motility, and gut permeability.
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References
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Nutrition Care Manual. https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=5522&lv2=19589&lv3=268528&ncm_toc_id=268528&ncm_heading=Nutrition Care. Accessed August 27, 2021. Irritable Bowel Syndrome
S; PTJALNG. Effect of Structural Individual Low-FODMAP Dietary Advice vs. Brief Advice on a Commonly Recommended Diet on IBS Symptoms and Intestinal Gas Production. Nutrients. https://pubmed.ncbi.nlm.nih.gov/31766497/. Accessed September 1, 2021.
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Irritable Bowel Disease. - Nutrition Care Manual. https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=5522&lv2=19449&lv3=270372&ncm_toc_id=270372&ncm_heading=Nutrition Care. Accessed September 1, 2021.
Limdi JK. Dietary practices and inflammatory bowel disease. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153885/. Published July 2018. Accessed September 1, 2021.
Svolos V, Hansen R, Nichols B, Milling SI, Rissell R, Gerasimidis K. Treatment of Active Crohn’s Disease With an Ordinary Food-based Diet That Replicates Exclusive Enteral Nutrition. Gastro Journal. https://www.gastrojournal.org/article/S0016-5085(18)35398-8/fulltext?referrer=https://pubmed.ncbi.nlm.nih.gov/. Accessed September 1, 2021.
Fritsch J;Garces L;Quintero MA;Pignac-Kobinger J;Santander AM;Fernández I;Ban YJ;Kwon D;Phillips MC;Knight K;Mao Q;Santaolalla R;Chen XS;Maruthamuthu M;Solis N;Damas OM;Kerman DH;Deshpande AR;Lewis JE;Chen C;Abreu MT; Low-Fat, High-Fiber Diet Reduces Markers of Inflammation and Dysbiosis and Improves Quality of Life in Patients With Ulcerative Colitis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. https://pubmed.ncbi.nlm.nih.gov/32445952/. Accessed September 1, 2021.
Ford AC. Overlap Between Irritable Bowel Syndrome and Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2020;16(4):211-213.
Fairbrass KM, Costantino SJ, Gracie DJ, Ford AC. 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
Bercik P, Verdu EF, Collins SM. Is irritable bowel syndrome a low-grade inflammatory bowel disease?. Gastroenterol Clin North Am. 2005;34(2):235-vii. doi:10.1016/j.gtc.2005.02.007
Abdul Rani R, Raja Ali RA, Lee YY. Irritable bowel syndrome and inflammatory bowel disease overlap syndrome: pieces of the puzzle are falling into place. Intest Res. 2016;14(4):297-304. doi:10.5217/ir.2016.14.4.297
Fukuba N, Ishihara S, Tada Y, et al. Prevalence of irritable bowel syndrome-like symptoms in ulcerative colitis patients with clinical and endoscopic evidence of remission: prospective multicenter study. Scand J Gastroenterol. 2014;49(6):674-680. doi:10.3109/00365521.2014.898084