Irritable bowel syndrome in inflammatory bowel disease. Synergy in alterations ofthe gut-brain axis?

The presence of digestive symptoms associated with irritable bowel syndrome (IBS) in patients with inflammatory bowel disease (IBD) in remission is a topic of growing interest. Although there is heterogeneity in clinical studies regarding the use of IBD remission criteria and the diagnosis of IBS, the available data indicate that the IBD-IBS overlap would affect up to one third of patients in remission, and they agree on the finding of a negative impact on the mental health and quality of life of the individuals who suffer from it. The pathophysiological bases that would explain this potential overlap are not completely elucidated; however, an alteration in the gut-brain axis associated with an increase in intestinal permeability, neuroimmune activation and dysbiosis would be common to both conditions. The hypothesis of a new clinical entity or syndrome of Irritable Inflammatory Bowel Disease or Post-inflammatory IBS is the subject of intense investigation. The clinical approach is based on certifying the remission of IBD activity and ruling out other non-inflammatory causes of potentially treatable persistent functional digestive symptoms. In the case of symptoms associated with IBS and in the absence of sufficient evidence, comprehensive and personalized management of the clinical picture (dietary, pharmacological and psychotherapeutic measures) should be carried out, similar to a genuine IBS. (C) 2021 Elsevier Espana, S.L.U. All rights reserved.

Automated summary

The presence of digestive symptoms associated with irritable bowel syndrome in patients with inflammatory bowel disease in remission is of growing interest, affecting up to one third of patients in remission with a negative impact on mental health and quality of life. The pathophysiological bases for this overlap are not completely elucidated, but alterations in the gut-brain axis, intestinal permeability, neuroimmune activation, and dysbiosis may be common to both conditions.