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In our latest episode of Wrestling the Octopus: the IBD Patient Podcast, Nigel and I chat with Professor Peter Irving, IBD consultant at Guyâs & St Thomasâ Hospital in London, about the confusing but incredibly common overlap between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).
We were keen to record this episode as many IBD patients have an IBS overlap - and it can be devilishly hard to know if you're having an IBD flare or if it's IBS. Professor Irving shares some great tips on this.
What IBS Really Is
Professor Irving tells us that IBS is âa disorder of the interaction between the gut and the brainâ and requires abdominal pain plus changes in stool form or frequency. Itâs now classed as a disorder of gutâbrain interaction, not a âfunctionalâ problem - a term that often leaves patients feeling dismissed.
Why IBS Is More Common in IBD
About 30â40% of people with Crohn's disease or ulcerative colitis experience IBSâtype symptoms. Reasons include:
- đĽ Postâinflammatory sensitivity - like postâherpetic neuralgia after shingles
- đ Altered motility
- 𧍠Microbiome changes
- đ§ Psychological stress, which affects gutâbrain signalling
IBS vs an IBD Flare - How to Tell
Itâs tricky. Some clues point more toward active IBD:
- đ Nocturnal symptoms
- 𩸠Rectal bleeding
- âď¸ Weight loss
Often though, objective tests are needed:
- 𧪠Calprotectin
- đĽď¸ Ultrasound or imaging
- đš Endoscopy
Bile Acid Malabsorption - A Common Mimic
Especially in Crohnâs disease affecting the terminal ileum.
Testing options include:
- â˘ď¸ SeHCAT scanÂ
- đ Trial of bile acid sequestrants
Managing IBS Symptoms in IBD
Treatment depends on symptoms and patient preference:
- đż Antispasmodics (mebeverine, Buscopan)
- đ Peppermint oil (Colpermin)
- đ§ Ginger
- đ˝ Carefully-supervised loperamide
- đ Lowâdose tricyclic antidepressants for pain modulation
- đ§ Stressâmanagement and lifestyle support
- đĽ Dietetic input, which can be transformative
The Low FODMAP Diet
Professor Irving helped bring the low FODMAP diet from Australia to the UK.
It reduces fermentable carbohydrates that trigger gas, bloating, and diarrhoea, and can be useful in helping IBD patients to manage their IBS.
Itâs not meant to be longâterm - itâs a structured tool that helps patients regain control over gut health.
A Final Thought
IBS in the context of IBD is real, common and complex. With the right tests, the right conversations, and the right tools - from diet to medication to lifestyle - patients can feel heard, supported and empowered.
Professor Irving also has an IBD podcast of his own - called Digesting - alongside a set of international IBD experts at the BRIDGe Group. Listen here.
Follow Rachel at @bottomlineibd
Follow Nigel at @crohnoid
