Functional intestinal symptoms in patients with inflammatory bowel disease: recommendations of the American Gastroenterological Association (2019)

Abstract

The paper presents overview of the latest recommendations of the American Gastroenterological Association on the management of patients with functional intestinal symptoms (FIS). It was noted that the prevalence of irritable bowel syndrome (IBS) in patients with inflammatory bowel disease (IBD) amounts up to 39 % at average and more often observed at Crohn’s disease (CD) than at ulcerative colitis. The level of fecal calprotectin should be considered as a sensitive marker, allowing differential diagnosis between functional and inflammatory changes in intestine. The monitoring of fecal calprotectin is performed once every 3 — 6 months. In case of its increase, one can predict the risk of IBD exacerbation. In cases of appropriate symptoms, and if the fecal calprotectin level is elevated or borderline, a colonoscopy with a biopsy and histological examination is mandatory. At suspicious fibrostenosing CD form or if fistula is present, CT enterocolography is performed. Among the pathophysiological mechanisms that are potentially capable to affect the persistence of FIS in patients with IBD, inflammatory-associated deviations from the axis «central nervous system -gastrointestinal tract» are considered, mechanisms non-specifically associated with IBD, changes in the structure and function of the digestive tract due to IBD, such as malabsorption of bile acids, syndrome of intestinal bacterial overgrowth, exocrine pancreatic insufficiency, carbohydrate malabsorption and others. In the treatment of FIS and IBD, both non-drug (diet, psychotherapy) and drug-based symptom-based treatment methods can be used with account of the pathophysiological mechanisms. It has been concluded that at FIS and IBD combination, the restrictive diets, psychotherapy, antispasmodics and antidepressants, antibiotics (rifaximin) and probiotics are potentially useful. The additional randomized controlled trials are needed to work out more personalized approach to the management of patients with this pathology, as well as the study of new methods of treatment, such as fecal microbial transplantation.