Gastroenterology, Hepatology and Nutrition Section, Ertan Digestive Disease Center, University of Texas McGovern Medical School , Houston, TX, USA.
Expert Rev Gastroenterol Hepatol. 2021 Jan;15(1):5-8. doi: 10.1080/17474124.2021.1829469. Epub 2020 Nov 29.
Inflammatory bowel disease (IBD) patients in apparent clinical remission who present with irritable bowel syndrome (IBS)-like symptoms pose a diagnostic and therapeutic dilemma that is called post-IBD IBS. When associated with a diarrheal IBS presentation, this clinical syndrome is known as post-IBD IBS-D.
We review and describe the literature regarding the clinical overlap of IBD and IBS. We discuss prevalent theories regarding the pathophysiology of post-IBD IBS-D and whether this presentation represents coincident inherent IBS-D, IBS-D triggered by IBD, or an even more subtle level of IBD activity that is unrecognized by available laboratory modalities. We also discuss observations that post-IBD IBS-D patients harbor significantly increased colon mucosal eosinophils and appear to respond to a GI-hypoallergenic diet and budesonide therapy.
The symptoms overlap between IBD and IBS complicates diagnosis and subsequent management of patients with post-IBD IBS-D. In addition to current theories regarding the pathophysiology of this condition such as alterations in mucosal inflammation, the microbiota, mucosal permeability, and gut-brain interactions. This new avenue of eosinophilic colopathy and therapy directed toward food-derived immune response in patients with post-IBD IBS-D deserves additional investigation.
表现出肠易激综合征（IBS）样症状但处于明显临床缓解期的炎症性肠病（IBD）患者，构成了一个诊断和治疗上的难题，这种情况被称为 IBD 后 IBS。当伴有腹泻型 IBS 表现时，这种临床综合征被称为 IBD 后 IBS-D。
我们回顾并描述了关于 IBD 和 IBS 临床重叠的文献。我们讨论了关于 IBD 后 IBS-D 的发病机制的流行理论，以及这种表现是代表同时存在的固有 IBS-D、IBD 引发的 IBS-D，还是更微妙的未被现有实验室方法识别的 IBD 活动水平。我们还讨论了这样的观察结果，即 IBD 后 IBS-D 患者的结肠黏膜嗜酸性粒细胞明显增加，并且似乎对胃肠道低致敏饮食和布地奈德治疗有反应。
IBD 和 IBS 的症状重叠，使 IBD 后 IBS-D 患者的诊断和后续管理变得复杂。除了目前关于这种疾病发病机制的理论，如黏膜炎症、微生物群、黏膜通透性和肠-脑相互作用的改变外。针对 IBD 后 IBS-D 患者食物源性免疫反应的嗜酸性结肠炎和治疗新途径值得进一步研究。
