Many patients with IBD report persisting symptoms, despite resolution of the inflammatory process. Although by definition, a diagnosis of IBS cannot be made, the prevalence of ‘IBS in IBD’ surpasses the rate of IBS in the global population by fivefold. Because IBS-like symptoms are associated with a decreased quality of life and increased healthcare utilisation in IBD, diagnosis and treatment are necessary. In this review, we summarise the current knowledge on IBS-like symptoms in IBD. A pathophysiological common ground is present, which includes genetic susceptibility, environmental triggers, gut microbial dysbiosis, increased intestinal permeability, visceral hypersensitivity and involvement of brain–gut interaction. When symptoms persist after resolution of inflammation, other GI diseases should be excluded based on the chief complaint, considering any possible psychological co-morbidity early in the diagnostic work-up. Subsequent treatment should be initiated that is evidence-based and often multimodal, including classical and non-classical pharmacological agents as well as lifestyle and microbiota-based approaches, spanning the breadth of the gut, brain and its interaction. Treatment goals in this substantial part of the IBD population should be adapted to not only focus on treating the inflammation but taking care of the patient.

中文翻译：

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临床实践的最新进展：应对挑战——管理 IBD 中的 IBS 症状


许多 IBD 患者报告尽管炎症过程消退，但症状仍持续存在。虽然根据定义，无法诊断为 IBS，但“IBD 中的 IBS”患病率是全球人群中 IBS 患病率的五倍。由于 IBS 样症状与 IBD 患者的生活质量下降和医疗保健利用率增加有关，因此诊断和治疗是必要的。在本综述中，我们总结了目前关于 IBD 中 IBS 样症状的知识。存在病理生理学上的共同点，包括遗传易感性、环境触发因素、肠道微生物失调、肠道通透性增加、内脏超敏反应和脑-肠相互作用的参与。当炎症消退后症状持续存在时，应根据主诉排除其他胃肠道疾病，在诊断性检查的早期考虑任何可能的心理合并症。应开始循证且通常是多模式的后续治疗，包括经典和非经典药物以及基于生活方式和微生物群的方法，涵盖肠道、大脑及其相互作用的广度。应调整 IBD 人群中这一大部分的治疗目标，不仅要关注治疗炎症，还要关注患者。