MM19 Conference Book V1final

A substantial number of IBD patients
with normal faecal calprotectin level
experience IBS-type symptoms. These
patients exhibit similar features to
people diagnosed with IBS in the
general community, suggesting that the
conditions are not mutually exclusive
and may coexist in a considerable
number of IBD patients. A systematic
diagnostic approach is required to
assess IBD patients with IBS-type
symptoms as sub-clinical inflammation
may play a role in a proportion of
cases. Aliment Pharmacol Ther. 2013
Jul;38(1):44-51.
- Am J Gastroenterol. 2003;98:412-
419.`
“Symptoms compatible with IBS
were higher in patients with IBD
compared to non-IBD controls,
even those in remission.”
-Am J Gastroenterol. 2012 Oct;107(10):1474-18
{
Symptoms compatible with IBS were
significantly higher in patients with IBD
compared with non-IBD controls, even
among those felt to be in remission. IBStype
symptoms were also significantly
more common in CD than in UC
patients, and in those with active
disease. Management strategies for IBD
patients with symptoms suggestive of IBS
are required. Am J Gastroenterol. 2012
Oct;107(10):1474-82.
ibs
U
diarrhea
constipation
ibd
abd. pain/bloating
weight loss
motility disruption
&dysfunction
disturbed
microbiome
maldigestion &
malabsorption
malnutrition
“…57% of patients with CD and
33% of patients with UC in longstanding
remission, as assessed by
laboratory, clinical, and
endoscopical parameters, have
IBS-like symptoms.
-Am J Gastroenterol 2002;97(2):389–96. `
-World J Gastroenterol 2014 Oct
14;20(38):13999-4003
“OCTT was
significantly
delayed in IBD
patients, and more
in CD compared to
UC, and is thought
to be the cause of
=
the increased SIBO
in these patients.”
{
DRIVE CAREFULLY
HIDDEN INTERSECTION
-Dig Dis Sci. 2013 Sep;58(9):2594-8.
“almost non-existent” in
predominantly diarrheal
conditions of CD and UC, and
was more prevalent in IBS than in
either CD or UC. Dig Dis Sci. 2003;48(1):86-92
“…57% of patients with CD and
33% of patients with UC in longstanding
remission, as assessed by
laboratory, clinical, and
SIBO
endoscopical parameters, have
IBS-like symptoms.
-Am J Gastroenterol 2002;97(2):389–96. `
21).
“About 41.67% of IBS-D patients meeting
Rome III criteria have SIBO…” Zhonghua Yi Xue Za Zhi.
2016
Jun 28;96(24):1896-902.
S
ibs
U
Connecting the dots:
ibd
SIBO
{
is a cause of IBS
intestine does occur in
some IPAA patients and
needs to be kept in the
differential diagnosis.
- j.crohns.2014.01.007. Epub 2014 Jan
SIBO
IBS often co-exists with IBD
IBD causes SIBO
=
{
IBD, IBS & SIBO often present together
Separation Anxiety
5/17/2017
-J Gastroenterol Hepatol. 2015
Jun;30(6):990-4. doi: 10.1111/jgh.12908.
From [ileal] biopsie
microbiome
there appears a d
the UCafflicted
intestinal
(Ileum) even in the
absence of inflam
implicating barrier
microbial change
primary abnormal
UC that may play
causative role in d
development
- J Crohns Colitis. 2015 Dec 9
“OCTT is dela
is higher in UC
2014 Aug;8(8):859
10.1016/j.crohns.2014.0
IBD
IBS
IBS
IBS
IBD
Altered mucosal permeability
Interaction of luminal flora & mucosal immune system
Immune activation
Inflammation
Alterations in gut motility
Role for sustained life stressors in symptom expression
Psychological and neuroendocrine plays role in symptom
expression
Together At Last
Confusion of Identity
Inflammation
Immune Activation
Intestinal Permeability
Cytokine imbalances
IBS
SIBO
IBD
Altered microbiome
Interaction between microbiota and immune system
Role for pyscho-emotional, neuroendocrine & stress
IBD
Elemental Diet
IBS
MILD
IMMUNE ACTIVATION
INTENSIE
GUT INFLAMATION
SIBO
Continuum?
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