Can People With IBD Also Have IBS?

There Is Uncertainty About IBS And IBD Coexisting In The Same Patient

Could there be an overlap between IBD and IBS?. Image © Amber J Tresca

There is often confusion surrounding irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD): two common diseases of the digestive tract. Both conditions can cause symptoms of diarrhea, bloating, and pain, but that is the extent of their similarities. In most other ways, these conditions are completely distinct, and are treated with vastly different methods. Even so, due to their similar names and the overlap of their most-talked about symptoms, some people incorrectly use IBS and IBD interchangeably.

IBS and IBD are different conditions, but is it possible to have both conditions at the same time? One study found that some people may be first diagnosed with IBS before later being diagnosed with IBD (this was true more often for Crohn’s disease than ulcerative colitis). How would a patient and their caregiver begin to understand if symptoms are caused by IBS or IBD?

IBS Before A Diagnosis Of IBD?

There is a lack of research into the subject, and the idea that both conditions can occur in the same person is still controversial. One meta-analysis noted that some people with IBD continued to have digestive symptoms even when the IBD itself was found to be in remission. Why did those patients continue to experience symptoms? The authors came to the conclusion that those patients who continued to experience symptoms consistent with IBS may benefit from treatment taking both conditions into account.

Those with active Crohn’s disease were more likely to experience IBS-type symptoms. Having active IBD was also associated with more prevalent IBS-type symptoms.

Another study done in Manitoba found that before being diagnosed with IBD, patients may have had IBS-like symptoms for 3 years or more. The authors estimate that as many as 14% of the 396 IBD patients in their study were “likely or possible” to also have IBS.

Those patients who might also have IBS had digestive symptoms for a longer period of time before receiving a diagnosis of IBD. The authors concluded that the rate of IBS in patients who have IBD may be similar to the rate of IBS in the general public.

IBS, Or Inflammation?

Another theory about the IBS symptoms in IBD patients in remission is that there could be "occult" inflammation. In other words, the IBD could still be causing a low level of inflammation that might not be picked up by typical assessment methods, such as the Crohn's Disease Activity Index. Researchers have discovered that these patients have measurable levels of calprotectin, a protein that is associated with the type of inflammation that is caused by IBD. A low level of inflammation could still be causing certain symptoms, such as those that mimic IBS. 

Should IBS Be Treated In IBD Patients?

Just as there is a lack of good research about whether patients with IBD could also have IBS, there is even less insight into how patients with a possible diagnosis of IBS should be treated.

Treatment will need to be customized for each patient by their gastroenterologist. There is some speculation that tricyclic antidepressants, which may be used to treat IBS, may be helpful in patients who have IBS symptoms and IBD.

There is still much that is unclear about the possibility of IBS in patients with IBD, and how that affects diagnosis and treatment in the future. The course is still being charted, and there is research being done to untangle the overlap of IBD and IBS-like symptoms in some people. Until the picture is clearer, the best source of information on both digestive conditions — either singly or in concert — is your gastroenterologist.


Barratt SM, Leeds JS, Robinson K, et al. “Prodromal irritable bowel syndrome may be responsible for delays in diagnosis in patients presenting with unrecognized Crohn's disease and celiac disease, but not ulcerative colitis.” Dig Dis Sci. 2011 Nov;56(11):3270-5. doi: 10.1007/s10620-011-1783-y. 17 Mar 2014.

Burgmann T, Clara I, Graff L, et al. “The Manitoba Inflammatory Bowel Disease Cohort Study: prolonged symptoms before diagnosis--how much is irritable bowel syndrome?Clin Gastroenterol Hepatol. 2006 May;4(5):614-620. 17 Mar 2014.

Halpin SJ, Ford AC. “Prevalence of Symptoms Meeting Criteria for Irritable Bowel Syndrome in Inflammatory Bowel Disease: Systematic Review and Meta-Analysis 401.” Amer J Gastroenterol. 2012:107;1474-1482. doi:10.1038/ajg.2012.260. 17 Mar 2014.

Keohane J, O'Mahony C, O'Mahony L, et al. “Irritable bowel syndrome-type symptoms in patients with inflammatory bowel disease: a real association or reflection of occult inflammation?Am J Gastroenterol. 2010 Aug;105(8):1788, 1789-94; quiz 1795. doi: 10.1038/ajg.2010.156. 17 Mar 2014.

Quigley EM, Bernstein CN. “”Irritable bowel symptoms" in inflammatory bowel disease: diagnostic uncertainty meets pathological reality.” Am J Gastroenterol. 2012 Oct;107(10):1483-5. doi: 10.1038/ajg.2012.263. 17 Mar 2014.

Sydora MJ, Sydora BC, Fedorak RN. “Validation of a point-of-care desk top device to quantitate fecal calprotectin and distinguish inflammatory bowel disease from irritable bowel syndrome.” J Crohns Colitis. 2012 Mar;6(2):207-14. doi: 10.1016/j.crohns.2011.08.008. 17 Mar 2014.

Continue Reading