Many people with inflammatory bowel disease (IBD) continue experiencing stomach pain and digestive issues even after their condition improves. Researchers reviewed what causes these lingering symptoms and found they result from a mix of physical and emotional factors. The good news is that doctors now understand these symptoms better and have several treatment options, including dietary changes, therapy, and medications. This research helps explain why some IBD patients still struggle with their digestion and offers practical ways to feel better.
The Quick Take
- What they studied: Why people with controlled IBD (when inflammation is gone) still experience irritable bowel syndrome (IBS) symptoms like stomach pain and changes in bowel habits
- Who participated: This was a review of existing research rather than a new study with participants. It examined findings from many previous studies about IBD and IBS overlap
- Key finding: About one in three people with controlled IBD experience IBS-type symptoms, which appear to come from a combination of leftover inflammation, changes in gut bacteria, increased sensitivity to pain, and stress
- What it means for you: If you have IBD and still have stomach symptoms even when your inflammation is controlled, you’re not alone, and there are multiple treatment approaches worth trying—from diet changes to therapy to medications
The Research Details
This is a narrative review, meaning researchers examined and summarized findings from many existing studies about IBS symptoms in people with IBD. Rather than conducting a new experiment, they looked at what other scientists have discovered about why this happens and how to treat it. The researchers focused on understanding the connection between these two conditions and what causes symptoms to persist even when the main IBD inflammation is gone. They reviewed the latest evidence on diagnosis methods and treatment options available to patients and doctors.
This type of review is important because it brings together scattered information from many studies into one clear picture. It helps doctors understand that IBS symptoms in IBD patients aren’t just the disease coming back—they’re a separate but related problem that needs its own approach. By reviewing all available evidence, researchers can identify the best treatment strategies and help patients understand their symptoms better.
This review was published in a respected medical journal and examines current research evidence. However, because it’s a review rather than a new study, it depends on the quality of previous research. The authors acknowledge that more research is needed, particularly studies that track patients over time and identify specific biological markers to improve diagnosis.
What the Results Show
The research shows that about one in three people with controlled IBD experience IBS-type symptoms, including stomach pain, bloating, and changes in bowel movements. These symptoms appear to result from multiple overlapping causes rather than a single problem. The main factors include: low-grade inflammation that remains even after treatment, changes in the gut lining that make it more permeable (leaky), alterations in gut bacteria, increased sensitivity to pain signals in the digestive system, and psychological stress or anxiety. The review emphasizes that these aren’t separate conditions but rather a complex interaction of physical and emotional factors. Importantly, these lingering symptoms significantly reduce quality of life and can make it harder for doctors to determine what’s actually causing a patient’s problems.
The review identifies several challenges in diagnosis, noting that IBS symptoms in IBD can mimic other conditions like bacterial overgrowth or bile acid problems, making proper diagnosis difficult. The research also highlights that psychological factors—including anxiety and depression—play an important role in symptom severity. Additionally, the review notes that current diagnostic approaches often focus on ruling out disease activity rather than positively identifying IBS symptoms, which can delay proper treatment.
This review builds on previous understanding by emphasizing that IBS in IBD patients isn’t simply active disease returning. Instead, it represents a distinct problem requiring different management. The research aligns with growing recognition that gut-brain interactions and psychological factors are crucial in digestive health. It also supports the shift toward ‘biopsychosocial’ treatment approaches that address physical, dietary, and emotional aspects together rather than treating them separately.
Because this is a review of existing studies rather than new research, its findings depend on the quality and completeness of previous work. The review notes that many studies lack sensitive biomarkers (measurable indicators) to precisely diagnose IBS in IBD patients. Additionally, most research hasn’t followed patients over long periods, so we don’t fully understand how these symptoms change over time. The review also acknowledges that treatment recommendations are based on limited evidence in some areas, and more personalized approaches are needed.
The Bottom Line
If you have controlled IBD but still experience stomach symptoms, consider: (1) Discussing a low-FODMAP diet with your doctor or dietitian—this has moderate evidence of helping (moderate confidence); (2) Exploring brain-gut behavioral therapy or stress management—this shows promise for improving symptoms (moderate confidence); (3) Discussing medications like antispasmodics or neuromodulators with your doctor if symptoms persist (moderate confidence); (4) Addressing anxiety or depression with a mental health professional, as these significantly affect symptoms (high confidence). Work with your healthcare team to identify which combination works best for you.
This research is most relevant for people with IBD who have controlled inflammation but still experience digestive symptoms. It’s also important for doctors treating IBD patients. Family members and caregivers should understand that these symptoms are real and treatable. People with IBS alone (without IBD) may find some information helpful, but their treatment approach may differ. This research is less relevant for people with active IBD inflammation, who need different management strategies.
Dietary changes like the low-FODMAP diet may show improvement within 2-4 weeks. Behavioral therapy and stress management typically require 6-12 weeks to show meaningful benefits. Medications may work faster, with some providing relief within days to weeks. However, finding the right combination of treatments is often a gradual process requiring patience and communication with your healthcare team. Long-term management usually involves ongoing adjustments based on how you respond.
Want to Apply This Research?
- Track daily symptom severity (stomach pain, bloating, bowel frequency) on a 1-10 scale, along with meals eaten, stress level, and sleep quality. This helps identify patterns and triggers specific to your situation.
- Use the app to log which foods trigger symptoms, set reminders for stress-management activities (breathing exercises, meditation), and track medication or supplement use. Create a simple food diary to test the low-FODMAP diet systematically.
- Review your symptom patterns weekly to identify trends. Share this data with your healthcare provider to guide treatment decisions. Monitor how different interventions (diet changes, stress management, medications) affect your symptoms over 4-8 week periods to find what works best for you.
This review summarizes research findings but is not medical advice. If you have IBD or suspect you have IBS symptoms, consult with your gastroenterologist or healthcare provider for proper diagnosis and personalized treatment. The treatments discussed should only be started under medical supervision. This information is educational and should not replace professional medical evaluation, diagnosis, or treatment. Individual responses to treatments vary, and what works for one person may not work for another.