- Fast Five Quiz: Do You Know Key Differences Between Irritable Bowel Syndrome and Inflammatory Bowel Disease?
- IBS vs IBD
- What is IBS?
- Comparing IBD and IBS
- Symptoms of IBS
- Diagnosing IBS
- Causes of IBS
- IBS Treatment
- The Irritable Gut
- IBS vs IBD: What’s the Difference?
- Symptoms and Evidence
- Symptoms Outside of the GI Tract
- IBS vs IBD: Two Very Different Illnesses
- Table 1: The Different Characteristics of IBS & IBD
- BHealth Blog
- Question: What’s the difference between IBS and Crohn’s Disease? Could I have both?
- How to Manage Crohn’s Disease and IBS
- IBS Symptoms, Crohn’s Symptoms, or Both?
- How Treatment for Crohn’s and IBS Differs
- IBD & IBS – what’s the difference?
Fast Five Quiz: Do You Know Key Differences Between Irritable Bowel Syndrome and Inflammatory Bowel Disease?
Patients with IBS aged 50 years or older should have more extensive testing, including a colonoscopy. In patients with IBD, colonoscopy or sigmoidoscopy reveals that the rectum is almost always involved in UC, but it is frequently spared in CD. The disease can be limited to the rectum (proctitis); to the rectum, sigmoid, and descending colon (left-sided colitis); or to the entire colon (pancolitis). UC does not involve any other segment of the GI tract. Colectomy is curative. Colonoscopy with ileoscopy in the assessment of CD has a sensitivity of 74% and a specificity of 100%, leading to a positive predictive value of 100% as a diagnostic test.
The ESR and C-reactive protein (CRP) levels are often used as serologic markers for inflammation in patients with IBD; however, these findings are not specific. Measuring such inflammatory markers aids in monitoring disease activity and response to treatment. A small but significant number of patients with CD or UC may not have elevated ESR or CRP levels, even in the setting of significant active inflammation.
In patients with suspected IBS, a lactose-free diet for 1 week in conjunction with lactase supplements may be indicated. Improvement incriminates lactose intolerance, although the patient’s clinical history and response to a trial may be unreliable. Therefore, some gastroenterologists recommend a formal hydrogen breath test. Fructose intolerance must also be considered. Breath testing may also be used to evaluate for small intestinal bacterial overgrowth, as formal jejunal aspiration is now rarely performed.
Esophagogastroduodenoscopy is used for the evaluation of upper GI tract symptoms in patients with IBD, particularly in patients with CD. In patients with IBS, esophagogastroduodenoscopy with possible biopsy is indicated in patients with persistent dyspepsia, if weight loss or symptoms suggest malabsorption, or if celiac disease is a concern.
For more on the workup of IBS, read here.
IBS vs IBD
Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two distinct gastrointestinal disorders, though the differences between the two can be confusing for many people.
While they have some similar symptoms, IBS and IBD are not the same condition and they require very different treatments. It is essential to get an accurate diagnosis so that you can properly manage your condition.
What is IBS?
Irritable bowel syndrome is classified as a functional gastrointestinal disorder, which means there is some type of disturbance in bowel function.
IBS can cause a great deal of discomfort and it can severely affect your quality of life. Symptoms can range from mildly annoying to disabling, which negatively impacts a person’s self-image, their social life, and the ability to work or travel.
People with IBS are more likely to have other functional disorders such as fibromyalgia, chronic fatigue syndrome, chronic pelvic, or temporomandibular joint disorder, also known as TMJ.
Who gets IBS?
According to the International Foundation for Gastrointestinal Disorders:
IBS affects at least 10 to 15 percent of adults in the U.S.
Women are affected more often than men.
It is the disorder most commonly diagnosed by gastroenterologists.
It is one of the most frequently diagnosed conditions among U.S. physicians.
Symptoms often begin in late adolescence or early adult life, during times of emotional stress.
Comparing IBD and IBS
Classified as a disease
Classified as a syndrome, defined as a group of symptoms
Can cause destructive inflammation and permanent harm to the intestines
Does not cause inflammation; rarely requires hospitalization or surgery
The disease can be seen during diagnostic imaging
There is no sign of disease or abnormality during an exam of the colon
Increased risk for colon cancer
No increased risk for colon cancer or IBD
Symptoms of IBS
IBS symptoms and their intensity can vary from person to person. Symptoms often occur after eating a large meal or when you are under stress, and they are often temporarily relieved by having a bowel movement.
Chronic and persistent abdominal pain
Constipation alternating with diarrhea
Mucus in the stool
Abdominal bloating, or the sensation of feeling full
Abdominal distention, or swelling
The urge to move your bowels without being able to have a bowel movement
Anemia, bleeding, weight loss, and fever are symptoms of IBD, not IBS. If you are experiencing these symptoms, seek immediate medical treatment.
IBS is diagnosed based on your symptoms and elimination of other causes. Your doctor will take a detailed medical history and perform a thorough physical exam. Unlike IBD, IBS cannot be confirmed by visual examination or with diagnostic tools and procedures, though your doctor may use blood and stool tests, x-ray, endoscopy, and psychological tests to rule out other diseases.
Other criteria for diagnosing IBS includes having abdominal discomfort or pain for at least 12 weeks, even if non-consecutive, over the past 12 months, accompanied by at least two of the following symptoms:
relief upon defecation
onset associated with a change in your stool frequency
onset associated with a change in the form of your stool
Causes of IBS
Like with Crohn’s disease and ulcerative colitis, the cause of IBS is not fully understood. Researchers believe that while stress can aggravate IBS, the syndrome is actually caused by a disturbance between the brain and the gut.
Here’s how the gastrointestinal (GI) tract and the brain work together:
The GI tract is controlled by a complex system of sensory and motor nerves that exchange information among the organs, spinal cord, and brain.
The colon reacts to information by contracting or relaxing its muscles and secreting fluid or mucus.
During the normal digestive process, the colon’s muscle contractions moves food through to the rectum, while absorbing water and nutrients to create the stool that is passed in a bowel movement.
The muscles of the colon, sphincters, and pelvis use synchronized contractions to expel stool normally.
People with IBS often have irregular colon motility patterns, meaning the necessary muscle contractions are not functioning the way they should. The term “irritable” is used because the nerve endings in the lining of the bowel are unusually sensitive, and the nerves that control the muscles of the gut are unusually active.
IBS symptoms can be triggered by ordinary stimuli, including certain foods, stress, hormonal changes, and certain medications. The spasms can delay your bowel movement, which can lead to constipation if the stool loses too much water in the colon. Spasms can also cause diarrhea by pushing the stool through your colon so fast that the fluid cannot be absorbed.
There is no one-size-fits-all treatment plan for IBS. Available treatments target the symptoms to provide relief. Your healthcare provider can help you decide on the most appropriate course of treatment.
This is often the first line of treatment. In mild cases, IBS symptoms can be managed with dietary changes and stress reduction techniques.
This can be an important part of relieving symptoms in more severe cases, but there is no one medication that works for all IBS patients.
Some IBS patients benefit from seeing a therapist for cognitive behavioral therapy, stress management, or relaxation training. Acupuncture and gut-directed hypnotherapy have also shown some positive research results in treating IBS symptoms.
The Irritable Gut
IBS vs IBD: What’s the Difference?
People can be forgiven if they confuse irritable bowel syndrome (IBS) with inflammatory bowel disease (IBD). “IBS” and “IBD” sound the same. Both are very common illnesses that affect the gut. However, about the only features that they have in common are gut symptoms such as abdominal pain and diarrhea, a tendency to affect young people, chronicity, and our ignorance of their ultimate cause. It is unfortunate that the initials for these contrasting conditions are so similar.
To add to the confusion, “IBD” is used to describe two distinct, but different structural diseases: ulcerative colitis and Crohn’s disease. The former affects only the lining of the large intestine or colon, while Crohn’s disease may affect any part and all layers of the gut. For many reasons, which are not relevant to this discussion, these two inflammatory conditions are usually lumped together as IBD.
Symptoms and Evidence
The fundamental difference between IBS and IBD is that IBD is structural, and IBS is not. By “structural,” we mean that when we examine the gut by x-ray, endoscopy, surgery, or biopsy we can see structural damage to the gut. In IBD, this damage is caused by an inflammation whose origins are poorly understood, but whose consequences may require hospitalization, heavy-duty medication, nutritional support, and often surgery. In IBS, none of the forgoing is true. Examination of the gut of a person who has IBS will be unrevealing. We know IBS exists because patients have gut symptoms, and there is no other way to detect it.
Both affect people of all ages but they are particularly prominent in young people. Females are more likely to have IBS, and it affects all races. IBD has no gender preference and is most common in Jewish individuals and those with origins in Northern Europe. IBS appears to be a worldwide disorder, while IBD prefers the planet’s temperate zones. More than half of people who have IBS symptoms seek no medical attention, while few IBD sufferers can avoid it.
In IBD, the gut is damaged by the chronic inflammation. This damage is resisted by the body’s defences, resulting in fever and malaise. The disrupted intestines may bleed and anemia (low blood) is common. The inability to eat during attacks, and wasting of energy caused by the inflammation, result in weight loss and malnutrition.
There are no findings on physical examination that are characteristic of IBS. However, the structural damage of IBD may produce striking physical findings such as a mass in the abdomen, an abnormal communication of the gut with the skin (fistula), an anal abscess, or the physical features of weight loss and anemia.
Symptoms Outside of the GI Tract
In IBD, inflammation may occur beyond the gut in the skin, joints, and eyes for examples. The resulting dermatitis, arthritis, and iritis (red, sore eye) can be as debilitating as the IBD itself. None of these physical disabilities result from IBS, and having IBS does not predispose one to IBD, nor any other structural condition such as cancer, celiac disease, nor diverticulosis. While neither condition will shorten life expectancy, most of those with IBD will require surgery at some time during their illness.
Sometimes psychological disease is thought to be a part of IBS. Certainly, some patients who seek medical attention may also have psychosocial problems that require attention in their own right. However, there is little evidence that this is true of IBS overall, and psychosocial difficulties are found in some people with IBD as well. While many people with IBS complain of social inconvenience, embarrassment, fear of appearing in public, and work loss, these features are more universal and profound in IBD, as the foregoing comparisons imply. While IBD is described as a structural or “organic” disease, IBS is said to be functional or a disorder of function. None of these terms is entirely satisfactory.
IBS vs IBD: Two Very Different Illnesses
It is of vital importance to distinguish these two very different gut conditions. While both are chronic, the overall treatment and prognosis are very different. There are other important considerations. Because so may people have IBS, it is not surprising that some will also acquire IBD. That is, they may occur in the same patient due to chance. It is therefore crucial that the IBS symptoms in these patients not be confused with those due to IBD. The powerful, often expensive, sometimes-toxic drugs employed to treat IBD will not improve IBS symptoms. There are many reported instances where IBD has been “misdiagnosed” as IBS for years until finally the diagnosis is made. A more likely explanation is that IBS was present first (remember it is very common) and the IBD started later.
Finally, both IBD and IBS may be mistaken for other diseases such as appendicitis, diverticulitis, and chronic gut infections. Careful attention to the medical history and a thorough physical examination should avoid any such confusion.
Both IBD and IBS trouble many people. However, because of its propensity to damage the gut and other organs, IBD may produce disfigurement and sometimes-permanent physical disability. While there is no doubt IBS patients can suffer greatly from symptoms, their outlook is better than those who have IBD. A perusal of Table 1 illustrates many important reasons to distinguish the two conditions.
Table 1: The Different Characteristics of IBS & IBD
Irritable Bowel Syndrome
Inflammatory Bowel Disease
|Structural Change in Gut||No||Yes|
|Gender||More common in females||About equal|
|Race||All||More in Jewish, Less in Blacks|
|Geography||Worldwide||Highest in Canada|
|Seek health care||About 30%||Virtually all|
|Fever, Anemia, Rectal bleeding, malnutrition||No||Yes|
|Complications in Gut, Skin, Joints, Eyes||No||Yes|
|Life expectancy||Normal||Almost normal|
|Need for Surgery||No||Often|
W. Grant Thompson, MD, Emeritus Professor of Medicine
Image Credit: © bigstockphoto.com/Raymond Gregory
Table updated in 2015
Each month, we ask our expert panel to answer one of our reader’s questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.
Question: What’s the difference between IBS and Crohn’s Disease? Could I have both?
Answer: While both of these conditions seem to have similar symptoms, they are in fact different, and, yes, it is possible for someone to have both at the same time. Here’s a quick breakdown of the two:
Crohn’s Disease is a chronic, inflammatory bowel disease that affects parts of the digestive tract. Symptoms often include diarrhea, a frequent need to move your bowels, stomach pain, and bloating (all symptoms of IBS). However, with Crohn’s disease, patients also may notice things like vomiting, tiredness, weight loss, fever, or even bleeding. It’s not certain what causes Crohn’s disease, but most experts believe it is an abnormality in the immune system that can trigger the condition. Chron’s disease is also more common in those with a family history of the disease.
IBS (also called “spastic colon”) carries similar symptoms to Crohn’s disease – cue the diarrhea, frequent trips to the bathroom, and stomach pain. However, treatment for Crohn’s disease and IBS are different so it pays to be examined for both so that you understand what is causing your symptoms and you can treat it appropriately. Testing for both conditions can be done with a physical exam, blood test, and usually a colonoscopy or other type of endoscopy procedure.
If you experience any symptoms related to IBS or Crohn’s disease, make an appointment with your doctor today to get tested.
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How to Manage Crohn’s Disease and IBS
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Having Crohn’s disease — a chronic, inflammatory bowel disease (IBD) that can affect different parts of the digestive tract — doesn’t make you immune to other gastrointestinal ills. In fact, some people with Crohn’s disease also have irritable bowel syndrome (IBS), also called “spastic colon.” Here’s how to tell whether you have both conditions.
IBS Symptoms, Crohn’s Symptoms, or Both?
How can you tell if your diarrhea is a result of IBS or Crohn’s disease? It’s not always easy, says James Marion, MD, director of education and outreach for The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai Hospital in New York City. “The symptoms of Crohn’s disease and IBS are notoriously difficult to distinguish,” he says, “and this can be a source of serious confusion among patients and physicians, and can, on occasion, lead to misdiagnosis or misguided treatment.”
Diarrhea, abdominal pain, an urge to evacuate one’s bowels, or abdominal distension can be seen in both conditions,whereas “red flag symptoms such as weight loss, vomiting, fatigue, fever, or bleeding raise concern for Crohn’s disease or ulcerative colitis,” Dr. Marion says.
Sometimes testing can provide a more definitive answer about the cause of gastrointestinal symptoms. “The critical difference is determining the cause of the symptoms, which can be accomplished with a thorough physical exam, blood and stool tests, imaging, and colonoscopy to confirm the presence or absence of inflammation or anatomic stricture seen with Crohn’s disease,” Marion says.
How Treatment for Crohn’s and IBS Differs
Although the symptoms can be similar, treatment for Crohn’s and IBS differ, which is why it’s important to know which condition your symptoms are related to, Marion explains. Treatment for Crohn’s disease depends on the severity of your symptoms. For example, sometimes you may need steroids to control a flare. Or you might need medication that targets the proteins involved in the inflammatory process of Crohn’s.
Treating IBS, however, is largely aimed at easing symptoms. If you have diarrhea, some over-the-counter medications may help. Diet also plays a role in treating and preventing an IBS flare, according to the Crohn’s & Colitis Foundation of America.
Recommendations from the American College of Gastroenterology include consuming soluble fiber (such as psyllium) to relieve IBS symptoms. Probiotics may also ease the bloating and flatulence associated with IBS, the group says.
By contrast, there’s no specific nutrition plan for Crohn’s disease, but eating a healthy, well-balanced diet can help your immune system function better, which is beneficial to Crohn’s. In addition, you may notice that certain foods, known as “triggers,” worsen your symptoms. Avoid these triggers, and see if you feel better.
If you’re experiencing digestive symptoms you didn’t have before, or if your existing symptoms aren’t getting better, make an appointment with your doctor. By understanding if Crohn’s or IBS is behind your discomfort, you can take the steps you need to treat it.
IBD & IBS – what’s the difference?
Crohn’s disease can cause pain, fever, bleeding, bloating, ongoing abdominal infections, recurrent abscesses around the anus, unintended weight loss and an inability to eat. Crohn’s disease can occur in any portion of the gastrointestinal tract starting from the mouth, through the stomach, small intestine, colon, rectum, anus and peri-anal area. Crohn’s disease is further divided into stricturing disease (intestinal narrowing), penetrating disease (fistula/abnormal connection between organs) and inflammatory disease. Unfortunately, the majority of patients with Crohn’s disease will need an operation during their life (but new medications designed to help patients avoid surgery are becoming more effective), and optimal treatment occasionally involves a variety of medications, including steroids and biologics, and repeat operations. “Crohn’s disease is managed by a team that is dedicated to treating patients with IBD and consists of colorectal surgeons, gastroenterologists, dieticians, stoma therapists and many other members of the IBD team,” said Dr. Schwartzberg.
Ulcerative colitis is a disease that is confined to the large intestine (the colon and rectum) and can cause diarrhea, pain, fever, bleeding and unintended weight loss. Most patients do not need surgery to remove their colon and rectum; however, patients may need to be on long-acting medications that may additionally include the use of steroids and/or biologics.
“For patients who do need surgery, it is performed in stages (different operations) and involves removing the colon and rectum, which removes the disease ulcerative colitis, and then creating an ileo-pouch-anal-anastomosis, or ‘J-pouch,’ which allows the patient to not have an ileostomy bag (bag on the skin to collect stool),” Dr. Schwartzberg said. “Occasionally, the J-pouch does not work and specialized centers, like Mather Colorectal, can re-do the J-pouch so the patient can again live without an ileostomy bag,” said Dr. Schwartzberg. Ulcerative colitis is managed by a team that is dedicated to treating patients with IBD and consists of colorectal surgeons, gastroenterologists, dieticians and stoma therapists.
Indeterminant colitis is part of IBD; however, its symptoms and results of the tests make it impossible to tell which type of IBD the patient has, despite an extensive workup. Luckily, the majority of treatments for Crohn’s disease and ulcerative colitis are similar, so regardless of which type of IBD the patient has, the patient can still be treated by the IBD team. Often times, years after the diagnosis of Indeterminant colitis, the patient is eventually considered to have Crohn’s disease or ulcerative colitis.
Like IBS, the causes of IBD are unknown. It is thought that bacteria or viruses may trigger the body’s immune system to produce an inflammatory reaction in the intestinal tract. Some combination of hereditary, genetic, or environmental factors may also play a role in the development of IBD.