| Key Differences | ||
|---|---|---|
| IBS | IBD | |
| Distinct Symptoms | Abdominal pain that improves after a bowel movement | Bloody stools, fever, weight loss |
| Causes | Unknown, but likely microbiome (the community of microbes in the gut) changes, an overly sensitive digestive system, and/or a gut-brain miscommunication | Unknown, but likely a combination of a genetic predisposition and environmental triggers |
| Diagnosis | Made using a set of criteria (testing is not usually done) | Made using diagnostic tests such as colonoscopy, computed tomography (CT) scan, magnetic resonance imaging (MRI), and blood tests |
| Treatment | Antibiotics, antispasmodics, antidiarrheals, intestinal secretagogues, laxatives, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and 5-HT3 or 5-HT4 antagonists | Aminosalicylates (5-ASA), antibiotics, biologics and their biosimilars, corticosteroids, immunomodulators, small molecules, and surgery |
How Are Symptoms Different?
IBS and IBD have some similar symptoms. However, each disorder also presents differently among different people.
Similar Symptoms
Some symptoms related to both IBS or IBD are:
- Abdominal (belly) pain
- Bloating
- Bowel urgency (needing a toilet immediately)
- Diarrhea and/or constipation
- Gas
- Mucus in the stool
- Nausea
Distinct IBS Symptoms
Symptoms of IBS (gas, pain, bloating, diarrhea and/or constipation) can all occur with IBD. One difference is that with IBS, abdominal pain improves after a bowel movement.
Distinct IBD Symptoms
Symptoms of IBD that are not a part of IBS include:
- Blood in the stool
- Fever
- Pain in the joints
- Weight loss
Forms of IBD
IBD includes subtypes, including Crohn’s disease, ulcerative colitis, and indeterminate colitis. They are all on the spectrum of IBD. Crohn’s disease may cause inflammation in any section of the digestive system, while ulcerative colitis (and indeterminate colitis) mainly affects the colon. Each form is treated with slightly different medications and surgeries.
Causes
The causes of both IBS and IBD are poorly understood. More than one factor may lead to the onset of these disorders.
IBS
IBS has many causes, and developing IBS might result from one or more factors. Key to this is the brain-gut interaction. Your brain and gut have two-way communication through the nervous system, which is essential for normal functioning.
It’s thought that IBS results from changes to the nervous system and its role in digestive functions. The digestive system becomes more sensitive to food, emotional stress, or foreign organisms (viruses or bacteria). These changes to the nervous system could be caused by:
- A breakdown in the communication between the brain and the gut
- A digestive infection (including small intestinal bacterial overgrowth [SIBO])
- Changes in the gut microbiome (the bacteria, viruses, and other microbes that live in the digestive tract)
- Stress or adverse events (especially in early childhood)
Risk factors for IBS include:
- Anxiety, depression, or post-traumatic stress disorder
- Experiencing trauma (especially sexual)
- Female sex
- Genetic factors (a tendency may be inherited)
IBD
The causes of IBD aren’t well-defined or understood. A genetic predisposition plus an environmental trigger cause IBD. Together, these factors lead to an inappropriate inflammatory response centered on the digestive system.
Some suspected environmental triggers are:
- A change in the microbiome (caused by diet, environment, or antibiotics)
- Exposure to pesticides
- Psychological stress
- Smoking cigarettes
- Ultra-processed foods
Risk factors for developing IBD include:
- Anxiety or depression
- Antibiotics in early childhood
- Formula feeding in infants
- Having a close family member with IBD
- Low dietary fiber intake
- Stressful life events
- Vitamin D deficiency
How They Are Diagnosed
Diagnosing IBS or IBD is not always easy. IBS is diagnosed by applying standard criteria to a person’s history of symptoms and physical exam. IBD is frequently diagnosed with endoscopy (a procedure that looks inside the body using a flexible tube with a camera and tools), such as an upper GI or a colonoscopy.
IBS
The Rome Criteria are used to diagnose IBS based on the symptoms the person experiences. The most important symptom is abdominal pain at least one day each week during the previous three months.
Diarrhea, constipation, or a combination of these are also part of a diagnosis, resulting in categorizing it into subtypes based on these. The subtypes are IBS-D (IBS with diarrhea), IBS-C (IBS with constipation), or IBS-M (IBS with mixed symptoms).
An endoscopy procedure, such as a colonoscopy, does not diagnose IBS. It will not show any disease because IBS does not cause inflammation.
Blood in the stool, fever, and weight loss are not IBS symptoms.
IBD
IBD causes ulcers and inflammation in the digestive system. Along with the symptoms and the results of lab tests, finding changes in the digestive tract during an endoscopy points toward an IBD diagnosis. Diagnosing IBD may also include stool tests, a CT scan, and/or an MRI.
People can have both IBD and IBS. Some people with IBD in remission (the disease is no longer active) could still have symptoms. The cause of those symptoms could be IBS.
Treatment Differences
Medications for managing IBS and IBD differ. Surgery is one treatment for IBD, but it is not used for IBS.
IBS
The type of IBS dictates the medications used.
Some of these medications include:
- Antispasmodics such as Bentyl (dicyclomine), cimetropium, Buscopan (hyoscine), otilonium bromide, and pinaverium bromide, for any form of IBS
- Imodium (loperamide), an over-the-counter antidiarrheal used for IBS-D
- Intestinal secretagogues, Amitiza (lubiprostone), Ibsrela (tenapanor), Linzess (linaclotide), and Trulance (plecanatide), for IBS-C
- Laxatives, over-the-counter medications for IBS-C
- Lotronex (alosetron), a 5-HT3 antagonist for IBS-D
- Lyrica (pregabalin), an anticonvulsant, for any form of IBS
- Selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine), for any form of IBS
- Tricyclic antidepressants (TCAs), amitriptyline or desipramine, for any form of IBS
- Viberzi (eluxadoline), an opioid for IBS-D
- Xifaxan (rifaximin), an antibiotic for IBS-D
- Zelnorm (tegaserod), a 5-HT4 agonist for IBS-C
IBD
Many medication types are available to treat IBD, Including:
- Aminosalicylates (5-ASA), including Azulfidine (sulfasalazine), Dipentum (olsalazine), and mesalamine (Apriso, Canasa, Lialda, Pentasa, and Rowasa)
- Antibiotics including Cipro (ciprofloxacin) and Flagyl (metronidazole)
- Biologics and their biosimilars, including Cimzia (certolizumab pegol), Entyvio (vedolizumab), Humira (adalimumab), Remicade (infliximab), Simponi (golimumab), Skyrizi (risankizumab), Stelara (ustekinumab), Tremfya (guselkumab), Tysabri (natalizumab)
- Corticosteroids such as budesonide (Entocort and Uceris) and prednisone
- Immunomodulators including Imuran (azathioprine), Neoral (cyclosporine), methotrexate, Purinethol (mercaptopurine, 6-MP)
- Small molecules, including Rinvoq (upadacitinib), Velsipity (etrasimod), Xeljanz (tofacitinib), Zeposia (ozanimod)
Surgery is also a treatment for IBD. Types of surgery for IBD include:
- Colectomy, which is removing the colon
- Colectomy with ileal pouch-anal anastomosis (IPAA), where the small intestine is made into an internal pouch to hold stool
- Ileostomy, which is removing the colon, and a piece of the small intestine is brought through the abdomen to release stool (called a stoma)
- Fistula surgery, which repairs an abnormal tunnel between two organs
- Proctectomy, which is removing the rectum and anus
- Resection, which is removing a piece of intestine and reconnecting the two healthy ends
- Strictureplasty, which opens up narrowed parts of the intestine (called strictures)
How to Manage IBD or IBS
IBS
Some of the changes to diet and lifestyle recommended for IBS include:
- Avoiding foods that cause symptoms
- Adding more fiber to the diet (with caution to avoid bloating or other symptoms)
- Eating smaller meals on a regular schedule
- Getting more exercise
- Managing stress and trialing yoga, mindfulness, and meditation
- Receiving treatment for mental health concerns (such as with gut-directed psychotherapy)
- Reducing caffeine and alcohol
- Trying a diet low in carbohydrates called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols)
- Trying a peppermint oil supplement
IBD
Changes to diet and lifestyle recommended for people with IBD often include:
- Addressing mental health through various forms of therapy
- Eating a diet that includes a variety of fruit, vegetables, cereals, grains, nuts, seeds, and low-fat protein sources
- Getting physical activity
- Taking a vitamin D supplement if needed
- Trying the low-FODMAP diet with suspicion of IBS
Complementary and alternative medicine with less evidence showing benefits include:
- Acupuncture
- Cannabidiol (CBD) supplements
- Fish oil supplements
- Probiotics (beneficial microbes)
- Prebiotics (specialized plant fibers that feed the beneficial microbes in the gut)
- Turmeric supplements
When to See a Healthcare Provider
Having diarrhea, constipation, and bloating at certain times is common. When they become troublesome or last for more than a few days, seek care from a healthcare provider.
Abdominal pain is another reason to see a healthcare provider. If the pain is sudden and severe, head to a hospital emergency department.
Red flag symptoms (reasons for emergency care or an urgent appointment with a healthcare provider) include:
- Altered mental state, like confusion
- Blood in the stool
- Dizziness
- Losing consciousness
- Stool that appears black or tarry
Summary
IBS and IBD are different conditions, though both may occur in the same person. IBD causes inflammation that leads to a host of possible effects both inside and outside of the digestive system. It is diagnosed with testing that includes endoscopy, blood work, and sometimes other imaging.
IBS causes bloating, pain, diarrhea and/or constipation, but it does not cause inflammation. IBS and IBD are managed with different medications and lifestyle changes, making it essential to get a diagnosis.
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IBS vs. IBD: Understanding the Differences
Overview
Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) are both gastrointestinal disorders affecting millions. Despite some overlapping symptoms, they are fundamentally different in their causes, implications, and management strategies.
Key Differences Between IBS and IBD
| Aspect | IBS | IBD |
|---|---|---|
| Symptoms | Abdominal pain alleviated by bowel movements | Symptoms include bloody stools, fever, and weight loss |
| Causes | Unknown; likely involves gut microbiome changes, digestive sensitivity, or gut-brain communication issues | Unclear; thought to involve genetic factors and environmental triggers |
| Diagnosis | Based on symptom criteria, usually without extensive testing | Utilizes diagnostic tests like colonoscopy, CT scans, MRI, and blood tests |
| Treatment | Includes antidiarrheals, antispasmodics, and SSRIs | Encompasses aminosalicylates, biologics, corticosteroids, immunomodulators, and possibly surgery |
Symptom Profiles
Common Symptoms
Both IBS and IBD can manifest with similar gastrointestinal symptoms, including:
- Abdominal pain
- Bloating
- Sensation of urgent bowel movements
- Diarrhea and/or constipation
- Excessive gas
- Mucus in the stool
- Nausea
Unique Symptoms of IBS
IBS is characterized by abdominal discomfort that tends to improve after bowel movements, a key difference in its symptomatology.
Unique Symptoms of IBD
IBD symptoms extend beyond the gastrointestinal tract and may include:
- Presence of blood in stools
- Fever
- Joint pain
- Unintentional weight loss
Understanding Causes
IBS Causes
While the exact cause of IBS is not fully understood, it is believed that factors contributing to its development may include:
- Disruption in communication between the brain and gut
- Digestive infections
- Alterations in gut microbiota
- History of stress or trauma
IBD Causes
The etiology of IBD is complex and could be influenced by a combination of genetic predisposition and environmental factors. Suspected environmental triggers are:
- Changes in microbiome from various causes
- Exposure to pesticides
- Psychological stress
- Cigarette smoking
- Consumption of ultra-processed foods
Diagnosis Approaches
Diagnosing IBS
IBS is typically diagnosed through the Rome Criteria, which assesses symptoms such as abdominal pain frequency. Importantly, diagnostic tests like endoscopies do not show any inflammation as IBS does not induce physical changes in the intestines.
Diagnosing IBD
IBD diagnosis involves more extensive testing, including endoscopy, blood tests, and imaging studies, to identify inflammation and ulcers within the gastrointestinal tract.
Treatment Strategies
Managing IBS
Managing IBS typically includes dietary adjustments, psychological treatments, and a variety of medications tailored to symptoms:
- Antispasmodics
- Antidiarrheal agents
- Drugs specifically for constipation
- SSRIs and TCAs for mood regulation
Managing IBD
IBD management often requires a broader range of treatment options, including:
- Aminosalicylates
- Antibiotics
- Biologics and immunomodulators
- Corticosteroids
- Surgical interventions when necessary
Self-Management Strategies
For IBS Patients
Patients may consider the following lifestyle and dietary changes:
- Avoiding trigger foods
- Incorporating more fiber cautiously
- Smaller, regular meals
- Regular physical activity
- Stress management techniques
For IBD Patients
Similar lifestyle modifications along with a balanced diet rich in nutrients can be beneficial for IBD patients:
- Therapeutic interventions for mental health
- Diverse diet including fibers and low-fat proteins
- Sufficient physical activity
When to Seek Medical Advice
It’s crucial to consult healthcare professionals if gastrointestinal symptoms become severe or persistent. Immediate attention is necessary for:
- Sudden and intense abdominal pain
- Presence of blood in stools
- Signs of dehydration or unexplained weight loss
Conclusion
Understanding the differences between IBS and IBD is crucial for effective management and treatment. While both conditions share some symptoms, they diverge significantly in their underlying mechanisms, diagnostic processes, and treatment options. Proper medical guidance is essential for accurate diagnosis and developing a tailored approach to treatment.
