IBS and IBD - separate entities or on a spectrum?
The acute phase of IBD with inflamed gut and often ulcerated mucosa is clearly different from the apparently normal mucosa characteristic of IBS. However, more detailed assessment has detected immune activation, increased gut permeability, increased mucosal serotonin availability, abnormalities of enteric nerve structure and function, and dysbiosis in gut microbiota in IBS - all features seen in IBD. Furthermore, as treatments for inflammation in IBD have become more effective it is now apparent that ∼1 in 3 patients with IBD in remission from inflammation still have persistent abnormalities of sensation, motility and gut microbiota, which might cause IBS-like symptoms. This Perspective explores the overlap between IBS and IBD and their treatments, proposing future directions for research in this stimulating area.
NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and The University of Nottingham, Queens Medical Centre, E Floor West Block, Nottingham NG7 2UH, UK.
Robin
R
Spiller
NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and The University of Nottingham, Queens Medical Centre, E Floor West Block, Nottingham NG7 2UH, UK.
Giles
G
Major
D001921:Brain / Q000502:physiology; D003937:Diagnosis, Differential; D005544:Forecasting; D000069196:Gastrointestinal Microbiome; D041981:Gastrointestinal Tract / Q000502:physiology; D020022:Genetic Predisposition to Disease; D006801:Humans; D018928:Immunity, Mucosal / Q000276:immunology; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D007413:Intestinal Mucosa / Q000276:immunology; D007422:Intestines / Q000294:innervation; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D010539:Permeability; D012701:Serotonin / Q000378:metabolism; D015398:Signal Transduction / Q000502:physiology
D012701:Serotonin
Gut. 2009 Mar;58(3):367-78
19001059
Gastroenterology. 2008 Sep;135(3):781-6
18640117
Clin Sci (Lond). 1998 Jun;94(6):663-70
9854466
Gut. 1999 Jan;44(1):96-100
9862833
Gut. 2002 Sep;51(3):410-3
12171965
Gastroenterology. 2012 Mar;142(3):463-472.e3
22108191
Am J Gastroenterol. 2009 Feb;104(2):392-400
19174797
Nature. 2011 Jun 15;474(7351):307-17
21677747
Am J Physiol Regul Integr Comp Physiol. 2007 Jul;293(1):R64-9
17442783
Gastroenterology. 2011 Aug;141(2):507-16
21684281
Inflamm Bowel Dis. 2011 Sep;17(9):1863-73
21287660
PLoS One. 2012;7(6):e39242
22768065
Neurogastroenterol Motil. 2015 May;27(5):717-27
25824902
Neurogastroenterol Motil. 2016 Sep;28(9):1419-32
27132547
Aliment Pharmacol Ther. 2010 Sep;32(6):811-20
20629976
Gut. 2000 Dec;47(6):804-11
11076879
Acta Physiol (Oxf). 2008 Aug;193(4):311-23
18462271
Brain Behav Immun. 2010 Oct;24(7):1166-75
20600818
Gut. 2012 Sep;61(9):1284-90
22234979
Neurogastroenterol Motil. 2014 May;26(5):731-44
24597665
Am J Gastroenterol. 2013 May;108(5):786-95
23588235
Dig Dis. 2010;28(3):406-10
20926864
Inflamm Bowel Dis. 2012 Oct;18(10):1932-9
22344959
Inflamm Bowel Dis. 2008 Nov;14(11):1569-74
18521915
Aliment Pharmacol Ther. 2012 Dec;36(11-12):1009-31
23066886
Clin Gastroenterol Hepatol. 2008 May;6(5):545-55
18242143
Neurogastroenterol Motil. 2005 Dec;17(6):863-70
16336502
Neurogastroenterol Motil. 2005 Jun;17(3):410-4
15916628
Am J Gastroenterol. 2011 Jul;106(7):1290-8
21427712
Trials. 2007 Jun 25;8:17
17592647
Aliment Pharmacol Ther. 2014 Feb;39(3):302-11
24308871
Brain Behav Immun. 2005 Nov;19(6):540-6
16214025
Scand J Gastroenterol. 2015 Aug;50(8):942-51
25687629
Gut. 2011 Jul;60(7):923-9
21262918
Pain. 2008 Jul;137(1):147-55
17928145
Am J Gastroenterol. 2005 Aug;100(8):1796-804
16086717
Gastroenterology. 2002 Oct;123(4):1099-108
12360472
Dig Dis Sci. 1999 Apr;44(4):830-5
10219845
Gut. 2008 Apr;57(4):475-81
18198200
Int J Med Microbiol. 2014 May;304(3-4):464-75
24713205
Gut. 2012 Jul;61(7):997-1006
22180058
Dig Dis Sci. 2014 May;59(5):1001-11
24282051
Gut. 2014 Nov;63(11):1737-45
24310267
Q J Med. 1962 Jul;31:307-22
13878459
Nat Rev Gastroenterol Hepatol. 2013 Aug;10(8):473-86
23797870
Gut. 2008 May;57(5):582-90
18194988
J Crohns Colitis. 2015 Nov;9(11):1024-31
26221003
Cytokine. 1998 Apr;10(4):313-8
9617578
Gastroenterology. 2006 Aug;131(2):410-9
16890594
Gastroenterology. 2007 Mar;132(3):913-20
17383420
Pharmacol Res. 2012 Sep;66(3):226-34
22699012
Int J Colorectal Dis. 1998;13(2):61-7
9638489
Gut. 2010 Jun;59(6):767-74
20551462
Gut. 1999 Mar;44(3):400-6
10026328
Microsc Res Tech. 2003 Apr 1;60(5):503-15
12619126
Gastroenterology. 2002 Aug;123(2):450-60
12145798
Clin Gastroenterol Hepatol. 2015 Sep;13(9):1650-5.e2
25769413
J Nutr. 2012 Aug;142(8):1510-8
22739368
BMJ. 1997 Mar 15;314(7083):779-82
9080994
Clin Gastroenterol Hepatol. 2006 May;4(5):614-20
16630762
Gastroenterology. 2006 Feb;130(2):304-11
16472586
Gut. 2010 Sep;59(9):1213-21
20650926
Neuropeptides. 2016 Aug;58:127-34
26804239
Neurogastroenterol Motil. 2013 Jun;25(6):e406-17
23600853
Gastroenterology. 2003 Dec;125(6):1651-9
14724817
Gut. 2013 Jul;62(7):985-94
22684480
Gut. 2008 Jul;57(7):923-9
18252749
Gastroenterology. 2009 Aug;137(2):495-501
19361507
Gut. 2009 Oct;58(10):1333-41
19324867
Gut. 2000 Oct;47(4):497-505
10986209
Biol Pharm Bull. 2013;36(9):1406-9
23995650
Clin Gastroenterol Hepatol. 2007 Jun;5(6):714-20
17481962
Am J Gastroenterol. 2000 May;95(5):1213-20
10811330
Neurogastroenterol Motil. 2011 Nov;23(11):e479-88
21883703
Am J Gastroenterol. 2015 Feb;110(2):278-87
25623659
Gastroenterology. 2009 May;136(6):1979-88
19457422
J Crohns Colitis. 2014 Dec;8(12):1569-81
25223604
Nat Genet. 2015 Sep;47(9):979-86
26192919
Pain. 2005 Jun;115(3):398-409
15911167
Am J Gastroenterol. 2001 May;96(5):1499-506
11374689
Am J Gastroenterol. 2010 Sep;105(9):1994-2002
20372115
Am J Gastroenterol. 2009 Feb;104(2):404-10
19174795
Gastroenterology. 2006 Jan;130(1):34-43
16401466
Gastroenterology. 2004 Mar;126(3):693-702
14988823
Ann Gastroenterol. 2014;27(3):224-230
24974805
J Neurosci. 2008 Jan 9;28(2):349-59
18184777
J Pediatr Gastroenterol Nutr. 1989 Oct;9(3):307-13
2693681
Gut. 1997 Jun;40(6):767-74
9245931
J Crohns Colitis. 2012 Dec;6(10):965-90
23040452
Clin Gastroenterol Hepatol. 2005 Apr;3(4):349-57
15822040
Gastroenterology. 2010 Jul;139(1):249-58
20303355
Neurogastroenterol Motil. 2008 Apr;20(4):392-406
18208479
Inflamm Bowel Dis. 2015 Jun;21(6):1219-28
25844959
Am J Physiol Gastrointest Liver Physiol. 2003 Jul;285(1):G207-16
12646422
Dig Dis Sci. 2002 Jan;47(1):216-24
11837726
Inflamm Bowel Dis. 2015 Apr;21(4):870-8
25742399
Am J Physiol Gastrointest Liver Physiol. 2009 Mar;296(3):G685-95
19095763
Lancet. 1996 May 4;347(9010):1267
8622486
Lab Invest. 2012 May;92(5):769-82
22330338
Neurogastroenterol Motil. 2013 Sep;25(9):756-e578
23731196
Eur J Gastroenterol Hepatol. 1998 May;10(5):415-21
9619389
Gut. 2007 Jul;56(7):949-57
17303597
Am J Gastroenterol. 2003 Jul;98(7):1578-83
12873581
Gastroenterology. 2006 May;130(6):1588-94
16697722
Am J Physiol Gastrointest Liver Physiol. 2009 Jul;297(1):G215-27
19407218
Aliment Pharmacol Ther. 2000 Feb;14(2):155-61
10651655
Scand J Gastroenterol. 2014 Aug;49(8):942-9
24897131
Aliment Pharmacol Ther. 2004 Dec;20(11-12):1317-22
15606393
Gut. 2016 Jan;65(1):57-62
26069274
PLoS One. 2014 Sep 19;9(9):e106478
25238408
Aliment Pharmacol Ther. 2013 Jul;38(1):44-51
23668698
Psychoneuroendocrinology. 2012 Jan;37(1):65-77
21641728
Gastroenterology. 2011 May;140(5):1434-43.e1
21315720
Am J Gastroenterol. 2012 Oct;107(10):1474-82
22929759
Gastroenterology. 2002 Dec;123(6):2005-16
12454857
Inflamm Bowel Dis. 2011 Jun;17(6):1322-7
21058331
Eur J Clin Invest. 2009 May;39(5):375-83
19302562
Aliment Pharmacol Ther. 2007 Aug 15;26(4):535-44
17661757
Aliment Pharmacol Ther. 2001 Jul;15(7):959-64
11421870
Gut. 2014 Oct;63(10):1617-25
24334242
Gut. 2014 May;63(5):744-52
23878165
Scand J Gastroenterol. 2011 Jul;46(7-8):981-7
21623672
Gut. 2011 Dec;60(12):1671-7
21636646
Gastroenterology. 2006 Apr;130(5):1480-91
16678561
Inflamm Bowel Dis. 2007 Feb;13(2):175-81
17206699
Dig Dis Sci. 2012 Dec;57(12):3154-9
22699394
Am J Gastroenterol. 2006 Jun;101(6):1288-94
16771951
Gut. 2014 Aug;63(8):1293-9
24153250
Inflamm Bowel Dis. 2009 Jun;15(6):867-71
19090560
Am J Gastroenterol. 2010 Aug;105(8):1788, 1789-94; quiz 1795
20389294
Dig Dis Sci. 1995 Oct;40(10):2250-8
7587798
Inflamm Bowel Dis. 2013 Mar-Apr;19(4):712-9
23446335
JAMA. 2016 Jan 12;315(2):142-9
26757463