Diagnosis and management of functional symptoms in inflammatory bowel disease in remission

Abstract

it in the present work. We describe a problematic that comprises physiopathological uncertainties, diagnostic difficulties, as IBS-like symptoms are very similar to those produced by an inflammatory flare, and the necessity of appropriate management of these patients, who, although in remission, have impaired quality of life. Ultimately, from almost a philosophical point of view, the presence of IBS-like symptoms in IBD patients in remission supposes a challenge to the traditional functional-organic dichotomy, suggesting the need for a change of paradigm. Core tip: Many inflammatory bowel disease patients in remission suffer from ongoing gastrointestinal symptoms that resemble those of irritable bowel syndrome and that hinder their quality of life. We review the pathogenesis of these symptoms, their prevalence and the best management strategies. Author contributions: All authors contributed equally to this work. Conflict-of-interest statement:The authors declare no conflicts of interest. AbstractInflammatory bowel disease (IBD) patients in remission may suffer from gastrointestinal symptoms that resemble irritable bowel syndrome (IBS). Knowledge on this issue has increased considerably in the last decade, and it is our intention to review and summarize REVIEWSubmit a

Systematic review with meta‐analysis: the impact of a depressive state on disease course in adult inflammatory bowel disease

“…Finally, we excluded any study that exclusively used patient‐reported symptoms to quantify disease activity, for example, survey‐based studies. This was to minimise the potential confounding from gastrointestinal symptoms originating from co‐existing functional bowel disorders that can occur in the absence of active intestinal inflammation . This did not eliminate certain commonly used clinical scoring systems such as the CDAI that contain a component of patient‐reported symptoms in the score.…”

Ephrin‐B2 signaling in the spinal cord as a player in post‐inflammatory and stress‐induced visceral hypersensitivity

“…Repeated exposure to psychological stress indeed can trigger the onset of IBS and exacerbate pre‐existing IBS symptoms . In preclinical models, acute intestinal inflammation, as in ulcerative colitis (UC) patients, leads to VHS, not only during acute flares of inflammation but also persisting after resolution of the inflammatory response …”

“…5 In preclinical models, acute intestinal inflammation, as in ulcerative colitis (UC) patients, leads to VHS, not only during acute flares of inflammation but also persisting after resolution of the inflammatory response. [6][7][8][9] It is well recognized that VHS in IBS and UC patients in remission can result from increased activation and/or sensitization of afferent nerve terminals via the release of bioactive mediators such as histamine, serotonin, proteases, and cytokines. [10][11][12][13][14] However, although less well studied, VHS can also result from altered pain signaling at the level of spinal cord.…”

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

“…Moreover, overlaps have also been observed between these diseases with regard to clinical symptoms [15]. Notably, IBS-like symptoms are often found in UC patients who have no evidence of the ongoing clinical disease activity [6,8,16]. Numerous studies have demonstrated possible mechanisms related to the development of IBS-like symptoms in quiescent UC patients [14][15][16][17][18].…”