Irritable bowel syndrome and inflammatory bowel disease: interrelated diseases?

Abstract

In the past inflammatory bowel disease (IBD), celiac disease and irritable bowel syndrome (IBS) were regarded as completely separate disorders. Now, with the description of inflammation, albeit low-grade, in IBS, and of symptom overlap between IBS and celiac disease, this contention has come under question. Is there true overlap between these disorders? Despite the limitations of available data one cannot but be struck by some areas of apparent convergence: IBD and celiac disease in remission, lymphocytic colitis and microscopic inflammation in IBS, in general, and, especially, in the post-infectious IBS category. The convergence between latent celiac disease and sub-clinical IBD, on the one hand, and IBS, on the other, appears, based on available evidence, to be somewhat spurious and may largely relate to misdiagnosis, a phenomenon which may also explain the apparent evolution of IBS into IBD in some studies. Similarities between IBS and lymphocytic colitis are more striking and less readily dismissed; as for IBS, well documented instances of progression of lymphocytic colitis to full-blown IBD are infrequent, suggesting a true separation between this disorder and classical IBD. Do IBS and lymphocytic colitis represent different responses to similar triggers? Will some of the 'inflamed' IBS subgroup be reclassified as part of the spectrum of lymphocytic colitis in the future? Will inflammation emerge as a common underlying factor in the pathogenesis of IBS? The answer to these and many questions must await further study of this fascinating area.

Preventive effects of enzyme-treated rice fiber in a restraint stress-induced irritable bowel syndrome model

“…IBS has a heterogeneous clinical presentation that includes abnormal bowel movements and abdominal pain, which are also symptoms of inflammatory bowel disease (IBD) (8)(9)(10). In addition, Schoepfer et al reported that antibodies against flagellin, the primary structural component of bacterial flagellae, were significantly more frequent in IBS patients than in control patients (7).…”

Changing face of irritable bowel syndrome

“…Here, still the debate continues regarding potential overlap between IBS, IBD and celiac sprue [2] . Do reported instances of celiac sprue among patients with "typical" IBS, or the occurrence of IBS-type symptoms among IBD patients in apparent remission, reflect a true association between these disorders and, thereby, the effects of low grade inflammation on enteric nerve and muscle function, or does such apparent overlap simply serve to emphasize the non-specificity of many gastrointestinal symptoms?…”

Role for protease activity in visceral pain in irritable bowel syndrome

“…A history of a gastrointestinal infectious episode is also associated with the development of IBS in 18% of these patients (9). IBS can also appear in patients with inflammatory bowel disease (IBD) who are in remission (10). A unifying hypothesis for the generation of symptoms of IBS incorporates a central component (psychological factors), together with peripheral organ dysfunction (motility disorders, visceral hypersensitivity), possibly aggravated by microscopic inflammation and/or previous intestinal infection.…”