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Refractory inflammatory bowel disease—could it be an irritable bowel?

Nature Reviews Gastroenterology & Hepatology volume 10, pages 58–61 (2013)Cite this article

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Abstract

Patients with IBD who are apparently in remission—as indicated by normal blood tests, endoscopic findings and ultrasonography results—often continue to experience symptoms. Furthermore, despite these negative findings, there is a temptation to increase their anti-inflammatory medication in the hope that this approach would lead to some improvement. However, this strategy often seems to fail and can sometimes lead to adverse events. Consequently, when evidence of continuing inflammatory activity is lacking it might be appropriate to consider the possibility of co-existent IBS in these patients and to treat them for this condition. Dietary manipulation, antispasmodic agents, antidepressants (especially of the tricyclic variety) and even behavioural treatments might result in a worthwhile improvement of symptoms.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China

    Jie Meng

  2. Department of Gastroenterology, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, DN2 5LT, UK

    Anurag Agrawal

  3. Education and Research Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK

    Peter J. Whorwell

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  1. Jie Meng
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  2. Anurag Agrawal
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  3. Peter J. Whorwell
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All authors contributed equally to all aspects of the article.

Corresponding author

Correspondence to Peter J. Whorwell.

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Competing interests

A. Agrawal acted as a consultant for Ferring Pharmaceuticals, GE Healthcare, Shire UK, Tillots Pharma, Warner Chilcott; he has received honoraria from Ferring Pharmaceutical and Shire UK, and has received grant support from Danone Research. P. J. Whorwell has acted as a consultant for, or received research grant support from the following pharmaceutical companies: Almirall Pharma, Astellas Pharma, Boehringer–Ingelheim, Chr Hansen, Danone Research, GlaxoSmithKline, Heel GMBH, Ironwood Pharmaceuticals, Norgine, Novartis Pharmaceuticals, Proctor and Gamble, Rotta Research, Shire UK, Solvay Pharmaceuticals and Sucampo Pharmaceuticals. J. Meng declares no competing interests.

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Meng, J., Agrawal, A. & Whorwell, P. Refractory inflammatory bowel disease—could it be an irritable bowel?. Nat Rev Gastroenterol Hepatol 10, 58–61 (2013). https://doi.org/10.1038/nrgastro.2012.173

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