Functional bowel symptoms in quiescent inflammatory bowel diseases: role of epithelial barrier disruption and low-grade inflammation

Abstract

In quiescent IBD, IBS-like symptoms related to persistent subclinical inflammation associated with increased colonic paracellular permeability. A persistent increase in TNF-α in colonic mucosa may contribute to the epithelial barrier defects associated with abdominal pain in quiescent IBD, but not in IBS. Optimisation of anti-inflammatory therapy may be considered in quiescent IBD with IBS-like symptoms.

Negative Effects on Psychological Health and Quality of Life of Genuine Irritable Bowel Syndrome–type Symptoms in Patients With Inflammatory Bowel Disease

“…Secondly, although escalation of conventional immunosuppressant and biological therapies has been advocated previously in these patients, 3 current data do not support the efficacy of such drugs when objective evidence of disease activity is lacking. 19 In addition, this approach may be expensive and could expose patients to potential unnecessary risks associated with these therapies.…”

“…2 The etiology of these conditions is uncertain, although some of the proposed pathophysiological mechanisms, including dysregulation of the mucosal immune system and intestinal barrier dysfunction, may be shared. 3 Given that CD and UC are lifelong conditions without cure, there is the potential for patients to be faced with many years of chronic GI symptoms and, as IBS is a highly prevalent condition, it is also plausible that a proportion of these symptoms may be secondary to co-existent IBS. A recent systematic review and meta-analysis of studies reporting IBStype symptoms in IBD suggested an overall prevalence of between 35% and 44%.…”

Prevalence of Irritable Bowel Syndrome-like Symptoms in Japanese Patients with Inactive Inflammatory Bowel Disease

“…17 Such symptoms are thought to occur in approximately 30% to 50% of patients with inactive IBD, a considerably higher prevalence than in healthy control subjects. [8][9][10][11][12][13][14][15][16] These findings are of considerable interest as we attempt to deepen our understanding of the inactive IBD disease state.…”

“…However, recent reports suggest that IBD can manifest IBS-like symptoms such as diarrhea and abdominal pain, even after bowel inflammation has been eliminated and the patient has entered clinical remission or mucosal lesions have healed. [8][9][10][11][12][13][14][15][16] This has been attributed to the persistence of microinflammation in the mucosa and to increased permeability of the gastrointestinal mucosa. 17 Such symptoms are thought to occur in approximately 30% to 50% of patients with inactive IBD, a considerably higher prevalence than in healthy control subjects.…”

“…[8][9][10][11][12][13][14][15][16] This has been attributed to the persistence of microinflammation in the mucosa and to increased permeability of the gastrointestinal mucosa. 17 Such symptoms are thought to occur in approximately 30% to 50% of patients with inactive IBD, a considerably higher prevalence than in healthy control subjects. [8][9][10][11][12][13][14][15][16] These findings are of considerable interest as we attempt to deepen our understanding of the inactive IBD disease state.…”