Review article: A practical approach to persistent gastrointestinal symptoms in inflammatory bowel disease in remission

Abstract

SummaryBackgroundPersistent gastrointestinal symptoms are prevalent in adult patients with inflammatory bowel disease (IBD), even when endoscopic remission is reached. These symptoms can have profound negative effects on the quality of life of affected patients and can be difficult to treat. They may be caused by IBD‐related complications or comorbid disorders, but they can also be explained by irritable bowel syndrome (IBS)‐like symptoms.AimsTo provide a practical step‐by‐step guide to diagnose and treat persistent gastrointestinal symptoms in patients with IBD in remission via a personalised approach.MethodsWe scrutinised relevant literature on causes, diagnostics and treatment of persistent gastrointestinal symptoms (abdominal pain or discomfort, bloating, abdominal distension, diarrhoea, constipation and faecal incontinence) in patients with IBD in remission.ResultsA graphical practical guide for several steps in diagnosing, identifying potential triggers and adequate treatment of persistent gastrointestinal symptoms in IBD in remission is provided based on supporting literature. The first part of this review focuses on the diagnostic and treatment approaches for potential IBD‐related complications and comorbidities. The second part describes the approach to IBS‐like symptoms in IBD in remission.ConclusionsPersistent gastrointestinal symptoms in IBD in remission can be traced back to potential pathophysiological mechanisms in individual patients and can be treated adequately. For both IBD‐related complications and comorbidities and IBS‐like symptoms in IBD in remission, pharmacological, dietary, lifestyle or psychological treatments can be effective. A systematic and personalised approach is required to reduce the burden for patients, healthcare systems, and society.

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“…In patients with IBD who do not have active inflammation, the prevalence of IBS-like symptoms is ranging up to 41%, according to pooled data. This is higher than the prevalence of IBS in the general population, which ranges from 3% to 9% [ 57 ]. Whether the pathophysiology of IBS-like symptoms in IBD in remission is similar to that of IBS remains unknown.…”