Irritable Bowel Syndrome-Like Symptoms in Ulcerative Colitis Patients in Clinical Remission: Association with Residual Colonic Inflammation

Abstract

Ulcerative colitis (UC) patients in clinical remission often experience irritable bowel syndrome (IBS)-like symptoms. The prevalence rate of UC patients meeting the definition of IBS, such as shown by the Rome criteria, is significantly higher in those without ongoing clinical activity as compared to healthy controls. Several studies have investigated residual low-grade inflammation found in colonic mucosa of quiescent UC patients and its association with development of IBS-like symptoms. In these patients, residual colonic inflammation was evaluated using endoscopy and histology findings, as well as fecal calprotectin level and shown to not be simply associated with the presence of IBS-like symptoms in UC patients in clinical remission. However, these results are limited by the low number of related investigations conducted. Additional appropriately designed studies are necessary to confirm the relationship of low-grade colonic inflammation with IBS-like symptoms associated with UC.

Prevalence and risk factors of bowel symptoms in Korean patients with ulcerative colitis in endoscopic remission: a restrospective study

“…Low-grade in ammation may be associated with altered enteric nervous system and microbiota, similar to IBS. However, some discrepancies were reported between IBS-like symptoms and fecal calprotectin levels in patients with UC [13]. In the present study, female sex was a signi cant risk factor of increased SF, which appears similar to IBS.…”

“…Second, we did not assess histological ndings of endoscopically quiescent UC. The presence of histologic bowel in ammation in the absence of endoscopic activity may be the cause of bowel symptoms [13]. Fecal calprotectin levels, which correlate with mucosal activity, were not assessed in the majority of the enrolled patients.…”

“…In previous studies, irritable bowel-like symptoms were more commonly reported in patients with in ammatory bowel disease (IBD) with low disease activity (33-46%) than in healthy controls (7%) or patients with irritable bowel syndrome (IBS; 8%) [10][11][12]. Previously, IBS was considered completely different from IBD; however, recent studies have suggested that some overlap may exist between these two disease entities [13]. Although the degree of in ammation and visceral hypersensitivity between IBD and IBS are different, they have similarities regarding the brain-gut axis, some genetic factors, dysbiosis, and impaired epithelial barrier function [14].…”

Fecal microbiota Profiling in Irritable Bowel Syndrome and Inflammatory Bowel Disease Patients with Irritable Bowel Syndrome-Type Symptoms

“…Previous studies have con rmed that the disease activity of IBD patients is closely related to a decrease of anti-in ammatory bacteria species and an increase of pro-in ammatory bacteria species, as well as the decrease of overall alpha diversity [33]. But some patients in remission of IBD suffer from varying degrees of IBS-like symptoms [34,35]. Is there any relationship between the intestinal ora of IBD patients with IBS like symptoms and that of IBS patients?…”

Does propolis affect the quality of life and complications in subjects with irritable bowel syndrome (diagnosed with Rome IV criteria)? A study protocol of the randomized, double-blinded, placebo-controlled clinical trial

“…According to the Bristol Stool Form Scale (BSFS), IBS is classified into diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), and mixed form (IBS-M). This functional bowel disease affects approximately 10% of the general population [4].…”