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Copyright ©The Author(s) 2019.
World J Gastroenterol. Aug 21, 2019; 25(31): 4414-4426
Published online Aug 21, 2019. doi: 10.3748/wjg.v25.i31.4414
Table 1 Common symptoms of overlapping gastrointestinal disorders in inflammatory bowel disease patients
DiseaseSymptoms
Bile-acid malabsorptionDiarrhea, urgency
Exocrine pancreatic insufficiencyAbdominal discomfort, bloating, diarrhea, greasy stools
Carbohydrates intoleranceAbdominal discomfort, bloating, diarrhea
Small intestinal bacterial overgrowthAbdominal discomfort, bloating, constipation, diarrhea, distention, sensation of incomplete evacuation, urgency
Small intestinal fungal overgrowthAbdominal discomfort, bloating, diarrhea, distention, urgency
Dyssynergic defecationAbdominal discomfort, bloating, constipation, diarrhea, distention, sensation of incomplete evacuation, straining, urgency
Ehlers-Danlos syndromes-hypermobility typeAbdominal pain, bloating, constipation, distention, sensation of incomplete evacuation, straining, pelvic floor dysfunction
Mast cell activation syndromeAbdominal discomfort, bloating, dynamic allergies, diarrhea, distention, sensation of incomplete evacuation, urgency
Eosinophilic gastroenteritisAbdominal pain, bloating, diarrhea
Intra-abdominal adhesionsAbdominal pain, bloating, distention
Irritable bowel syndromeAbdominal discomfort, bloating, diarrhea /constipation, distention, sensation of incomplete evacuation, urgency
Celiac diseaseAbdominal discomfort, bloating, diarrhea
GiardiasisAbdominal discomfort, bloating, diarrhea
Table 2 Causes of irritable bowel syndrome-like symptoms in inflammatory bowel disease patients
DiseaseDiagnosisTreatment
Small bowel CDComputed tomography or magnetic resonance enterographyDrug escalation or surgery
Bile-acid malabsorption75SeHCAT, 48-hour fecal bile acids, trial with bile acid bindersBile acid sequestrants
Exocrine pancreatic insufficiencyFecal elastase1, trial with pancreatic enzymesPancreatic enzyme replacement
Carbohydrates intoleranceHydrogen breath testDietary restriction
Small intestinal bacterial overgrowthLactulose or glucose breath tests: rise from baseline in H2 ≥ 20 ppm within 90 min or CH4 ≥ 10 ppmH2: Rifaximin, doxycycline or amoxicillin CH4: Rifaximin and neomycin, or rifaximin and metronidazole, or amoxicillin-clavulanate or ciprofloxacin and metronidazole
Small intestinal fungal overgrowthQuantitative culture of intestinal aspirate ≥ 103 CFU/mLAnti-fungal therapy (e.g., fluconazole)
Dyssynergic defecationAnorectal manometry with balloon expulsion test, defecographyBiofeedback behavior therapy
Ehlers-Danlos syndrome-hypermobility typeBeighton score ≥ 4[105] and arthralgia, erect barium testing for visceroptosisPelvic physiotherapy, promotility agents
Mast cell activation syndromeTypical symptoms, elevated mast cell mediators (e.g., tryptase) and response to mast cell stabilizing agentsH1 blockers, H2 blockers, cromolyn sodium, referral to hematologist/allergist
Eosinophilic gastroenteritisEosinophilic infiltration on pathologyAnti-inflammatory agents
Intra-abdominal adhesionsClinical history, previous history of adhesionsConsideration of surgical lysis of adhesions
GiardiasisDetection of Giardia lamblia antigens in stoolMetronidazole or nitazoxanide
Celiac diseaseIgA anti-tissue transglutaminase and serum total IgA, EGD with duodenal biopsiesGluten-free diet