Irritable Bowel Syndrome – Type Symptoms in Patients With Infl ammatory Bowel Disease : A Real Association or Refl ection of Occult Infl ammation ?

© 2010 by the American College of Gastroenterology The American Journal of GASTROENTEROLOGY INTRODUCTION Clinicians are frequently challenged to interpret gastrointestinal symptoms in patients with infl ammatory bowel disease (IBD) who, on the basis of conventional tests, appear to be in remission. In two separate studies, irritable bowel syndrome (IBS)-type symptoms were described in 33 % of patients with ulcerative colitis (UC) and in 42 – 57 % with Crohn ’ s disease (CD), who were in remission ( 1,2 ). How does the clinician interpret such symptoms? Do they refl ect the coincident occurrence of IBS or the presence of persistent, but clinically undetected, lowgrade infl ammation? Th is management dilemma is particularly problematic in CD and, especially in those with disease confi ned to the small bowel, where frequent disease monitoring is logistically diffi cult. Th ere is a statistically defi nable likelihood of coincidence of IBD and IBS, as both syndromes are common with prevalence rates in the developed world for IBD ranging between 0.1 and 0.2 % ( 3 ) and for IBS from 9 to 12 % ( 4,5 ) and both may signifi cantly impact on quality of life (QOL) ( 6 – 10 ). However, in the absence of an identifi able cause, or a specifi c biomarker for either condition, both IBS and IBD are diagnosed clinically as being mutually exclusive. In both cases, diagnosis requires not only the presence of compatible clinical features with chronicity, but also, the exclusion of diff erential diagnoses. For patients with an established diagnosis of IBD, optimal management requires that disease activity be monitored accurately and treated promptly to minimize long-term complications. Th e risk of unnecessary and undesirable use of corticosteroids or other durgs arises in Irritable Bowel Syndrome – Type Symptoms in Patients With Infl ammatory Bowel Disease: A Real Association or Refl ection of Occult Infl ammation ?