Inflammatory bowel disorder (IBD) and irritable bowel syndrome (IBS) sound like possibly interchangeable names for the same problem. In fact, IBD and IBS are quite different, though they have similarities, as an examination of the pathophysiological mechanisms reveals. IBD is actually a combination of two disorders, ulcerative colitis (UC) and Crohn’s disease (CD) (Cheng, Shah, & Gonzalez, 2012; Park & Pfeil, 2015). The UC aspect of IBD “is characterized by continuous mucosal inflammation beginning at the rectum and extending for a variable distance proximally,” where the affected mucosa is “friable, granular, ulcerated, and bleeds easily” (Park & Pfeil, 2015). The CD aspect also involves inflammation, though it is described as “transmural” and “patchy” involving the “entire gastrointestinal tract from the mouth to the anus” (Park & Pfeil, 2015).
Much like IBD, IBS is actually a collection or problems composed of “abnormalities in motility, visceral sensation, brain-gut interaction, and psychosocial distress” (Chey, Kurlander, & Eswaran, 2015). Its pathophysiology appears to be as much about environmental factors as it does patient-related (sometimes called host) factors, much like IBD (Cheng, Shah, & Gonzalez, 2012; Chey, Kurlander, & Eswaran, 2015; Park & Pfeil, 2015). Some of the host factors are dysbiosis (microbial imbalance), increased permeability of the intestines, increase activation of the gut mucosal immune system, and visceral hypersensitivity” (Chey, Kurlander, & Eswaran, 2015). Increased permeability of the intestines has also been implicated in Crohn’s disease (Camilleri, Lasch, & Zhou, 2012), so it shares that element with IBD. IBS also features some inflammation due to immunoreactions as well as mucosal involvement (Camilleri, Lasch, & Zhou, 2012) like IBD (Cheng, Shah, & Gonzalez, 2012; Park & Pfeil, 2015). However, IBS seems to feature psychological aspects not present in IBD (Chey, Kurlander, Eswaran, 2015).
Common treatments for IBD depend on the severity of UC and CD; the goal of treatment is to “first induce remission and then maintain remission” (Park & Pfeil, 2015). Primarily, treating the inflammation is key to management – corticosteroids (particularly enteric ones), aminosalicylates, immunomodulators, antiobiotics, and biologics are used (Cheng, Shah, & Gonzalez, 2012; Park & Pfeil, 2015). Treatment for IBS is usually focused on managing symptoms both physiological (like controlling diarrhea) and psychological (like handling stress and depression) (Camilleri, Lasch, & Zhou, 2012; Chey, Kurlander, Eswaran, 2015). Treatments for diarrhea and inflammation could be used in both IBS and IBD. However, given the lack of psychological dimension to IBD, the psychological treatment aspects of IBS would not apply.
When considering patient factors that might impact the pathophysiology of and treatments for these disorders, gender emerges as an interesting point. IBD seems to occur more often in men than in women, partially based on demographic data demonstrating that men are more likely to develop the disorder (Park & Pfeil, 2015) while IBS seems to occur more often in women (Camilleri, Lasch, & Zhou, 2012). This differences in IBD and IBS regarding gender appears to be related to differences in environmental exposures and immune reactions (Camilleri, Lasch, & Zhou, 2012; Cheng, Shah, & Gonzalez, 2012; Chey, Kurlander, & Eswaran, 2015; Park & Pfeil, 2015). Some researchers have attributed these differences to differences owing to hormonal differences between genders; this seems supported in the use of certain hormones in the treatment of IBD (Zelinkova & der Woude, 2014). In terms of how gender might affect the treatments involved in each disorder, the dangers commonly associated with hormone therapy would apply. Zelinkova and der Woude (2014) also observe that women with IBD appear to undergo surgery more often than men, seemingly as a consequence of treatment noncompliance which raises questions about the effect of gender on treatment compliance in general.
- Camilleri, M., Lasch, K., & Zhou, W. (2012). Irritable bowel syndrome: methods, mechanisms, and pathophysiology. The confluence of increased permeability, inflammation, and pain in irritable bowel syndrome. American Journal of Physiology-Gastrointestinal and Liver Physiology, 303(7), G775-G785.
- Cheng, J., Shah, Y. M., & Gonzalez, F. J. (2012). Pregnane X receptor as a target for treatment of inflammatory bowel disorders. Trends in Pharmacological Sciences, 33(6), 323-330.
- Chey, W. D., Kurlander, J., & Eswaran, S. (2015). Irritable bowel syndrome: A clinical review. JAMA, 313(9), 949-958. doi:10.1001/jama.2015.0954
- Park, J. R., & Pfeil, S. A. (2015). Primary care of the patient with inflammatory bowel disease. Medical Clinics of North America, 99, 969-987. doi:10.1016/j.mcna.2015.05.009
- Zelinkova Z. & der Woude, C.J. (2014). Gender and inflammatory bowel disease. Journal of Clinical Cell Immunology, 5(245). doi: 10.4172/2155-9899.1000245
