Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: Prevalence, diagnosis and treatment

Table 1 Common symptoms of overlapping gastrointestinal disorders in inflammatory bowel disease patients

Disease	Symptoms
Bile-acid malabsorption	Diarrhea, urgency
Exocrine pancreatic insufficiency	Abdominal discomfort, bloating, diarrhea, greasy stools
Carbohydrates intolerance	Abdominal discomfort, bloating, diarrhea
Small intestinal bacterial overgrowth	Abdominal discomfort, bloating, constipation, diarrhea, distention, sensation of incomplete evacuation, urgency
Small intestinal fungal overgrowth	Abdominal discomfort, bloating, diarrhea, distention, urgency
Dyssynergic defecation	Abdominal discomfort, bloating, constipation, diarrhea, distention, sensation of incomplete evacuation, straining, urgency
Ehlers-Danlos syndromes-hypermobility type	Abdominal pain, bloating, constipation, distention, sensation of incomplete evacuation, straining, pelvic floor dysfunction
Mast cell activation syndrome	Abdominal discomfort, bloating, dynamic allergies, diarrhea, distention, sensation of incomplete evacuation, urgency
Eosinophilic gastroenteritis	Abdominal pain, bloating, diarrhea
Intra-abdominal adhesions	Abdominal pain, bloating, distention
Irritable bowel syndrome	Abdominal discomfort, bloating, diarrhea /constipation, distention, sensation of incomplete evacuation, urgency
Celiac disease	Abdominal discomfort, bloating, diarrhea
Giardiasis	Abdominal discomfort, bloating, diarrhea

Table 2 Causes of irritable bowel syndrome-like symptoms in inflammatory bowel disease patients

Disease	Diagnosis	Treatment
Small bowel CD	Computed tomography or magnetic resonance enterography	Drug escalation or surgery
Bile-acid malabsorption	75SeHCAT, 48-hour fecal bile acids, trial with bile acid binders	Bile acid sequestrants
Exocrine pancreatic insufficiency	Fecal elastase1, trial with pancreatic enzymes	Pancreatic enzyme replacement
Carbohydrates intolerance	Hydrogen breath test	Dietary restriction
Small intestinal bacterial overgrowth	Lactulose or glucose breath tests: rise from baseline in H2 ≥ 20 ppm within 90 min or CH4 ≥ 10 ppm	H2: Rifaximin, doxycycline or amoxicillin CH4: Rifaximin and neomycin, or rifaximin and metronidazole, or amoxicillin-clavulanate or ciprofloxacin and metronidazole
Small intestinal fungal overgrowth	Quantitative culture of intestinal aspirate ≥ 103 CFU/mL	Anti-fungal therapy (e.g., fluconazole)
Dyssynergic defecation	Anorectal manometry with balloon expulsion test, defecography	Biofeedback behavior therapy
Ehlers-Danlos syndrome-hypermobility type	Beighton score ≥ 4[105] and arthralgia, erect barium testing for visceroptosis	Pelvic physiotherapy, promotility agents
Mast cell activation syndrome	Typical symptoms, elevated mast cell mediators (e.g., tryptase) and response to mast cell stabilizing agents	H1 blockers, H2 blockers, cromolyn sodium, referral to hematologist/allergist
Eosinophilic gastroenteritis	Eosinophilic infiltration on pathology	Anti-inflammatory agents
Intra-abdominal adhesions	Clinical history, previous history of adhesions	Consideration of surgical lysis of adhesions
Giardiasis	Detection of Giardia lamblia antigens in stool	Metronidazole or nitazoxanide
Celiac disease	IgA anti-tissue transglutaminase and serum total IgA, EGD with duodenal biopsies	Gluten-free diet

¹False-positive results are observed in liquid stools. CD: Crohn’s disease; ⁷⁵SeHCAT: Selenium-75-homocholic acid taurine scan; CFU: Colony-forming unit; H1: Histamine 1 receptor; H2: Histamine 2 receptor; EGD: Esophagogastroduodenoscopy.