A substantial proportion of patients with inflammatory bowel disease in remission still have abdominal pain, altered bowel habit and bloating. Without a shared name or a defined pathway, the default response is to assume active disease and escalate immunosuppression — which exposes the patient to risk for a symptom the drug cannot fix.
A joint Rome Foundation and International Organization for the Study of IBD working team has produced the first consensus on this, using a modified RAND/UCLA appropriateness method. Thirteen panellists reviewed 133 candidate statements, of which 105 went to final scoring across two rounds: 86 were rated appropriate, 16 uncertain and 3 inappropriate.
The agreed term is 'IBD with IBS-like symptoms', defined as abdominal pain, bowel habit change or bloating not explained by active inflammation or structural disease. For clinical care, diagnosis should combine Rome clinical criteria with objective exclusion of inflammation — which means the faecal calprotectin or the scope comes first, and the label second.
On treatment, the panel endorsed psyllium where there is no stricture, a short-term low-FODMAP diet, targeted drugs, and brain-gut behavioural therapies.
The stricture caveat on psyllium is the practical detail most likely to cause harm if missed, and the low-FODMAP recommendation is explicitly short-term — it is a diagnostic and symptomatic manoeuvre, not a diet to leave a patient on indefinitely, particularly one already at nutritional risk. The value of the consensus is that it gives a clinician something to offer instead of escalating a biologic.
- Exclude active inflammation objectively before attributing symptoms to an IBS-like overlap
- Use the term 'IBD with IBS-like symptoms' so the record is unambiguous for the next clinician
- Do not escalate IBD therapy for symptoms occurring without inflammatory or structural explanation
- Offer psyllium only where there is no stricture, and use a low-FODMAP diet short-term rather than indefinitely
- Consider brain-gut behavioural therapy as an endorsed option rather than a last resort
The statistics, in plain English
This is a consensus document, not a trial, and the modified RAND/UCLA method produces agreement rather than evidence. The scoring pattern is worth reading as a map of certainty: of 105 statements, 86 were rated appropriate, 16 uncertain and 3 inappropriate. The 16 uncertain statements are where the panel could not agree, and those are precisely the questions a clinician will meet in clinic. Treat the appropriate-rated recommendations as expert practice standards, and remember that consensus strength does not measure effect size — none of these statements comes with a number attached.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for gastroenterology & hepatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free