New Consensus Bridges the Gap for Managing IBS-Like Symptoms in IBD Patients

For many patients with inflammatory bowel disease (IBD), symptoms like abdominal pain and bowel habit changes persist even after inflammation is under control—a frustrating overlap that blurs the line between IBD and irritable bowel syndrome (IBS). A joint effort between the International Organization for the Study of IBD (IOIBD) and the Rome Foundation has led to the first consensus guidelines, presented at DDW 2025, to help clinicians navigate this challenging clinical scenario.

Using a modified RAND/UCLA appropriateness methodology, an expert panel of 13 international specialists—including gastroenterologists, psychologists, and methodologists—developed 48 statements aimed at clarifying terminology, diagnostic criteria, and treatment strategies. Through 2 rounds of discussion and voting, the panel reached agreement on key recommendations.

The preferred terminology for this condition is “IBD with IBS-like symptoms”, reflecting the reality that a strict diagnosis of IBS is often inappropriate in the context of underlying IBD. The panel emphasized that this diagnosis should be considered when symptoms are not fully explained by the degree of inflammation or bowel damage and must be supported by a comprehensive evaluation—incorporating clinical assessment, biomarkers, endoscopy, imaging, and histology.

Management strategies endorsed by the panel include tailored dietary and pharmacological interventions based on predominant symptoms (e.g., diarrhea or constipation), as well as psychological therapies. Brain-gut behavior therapies, particularly GI-focused cognitive behavioral therapy, were found to be appropriate in improving not only gastrointestinal symptoms but also coexisting anxiety, depression, and overall quality of life.

By establishing these evidence-informed consensus recommendations, the IOIBD-Rome panel provides a long-needed framework to help clinicians support a subset of IBD patients whose symptoms persist beyond inflammation—addressing an unmet need in both routine practice and research settings.

Ma C, Ford AC, Hashash JG, et al.Joint IOIBD-Rome consensus recommendations for the evaluation and management of patients with inflammatory bowel disease with irritable bowel syndrome-like symptoms. Abstract Mo1248. Presented at: DDW 2025. May 3-6, 2025. San Diego, CA.