What is the difference between IBS and IBD?

Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are conditions involving the gastrointestinal tract that can often be confused due to similar names and some overlapping symptoms.

However, they have distinct characteristics and are treated differently, although diet may be part of the treatment plan in both disorders. Your child’s gastroenterologist will help you determine an accurate diagnosis to ensure proper management of your child’s condition. One thing to remember, a child with IBD may also be diagnosed IBS; however, IBS does not lead to IBD.

Treatment with Diet

Many diet therapies have been studied with both IBS and IBD and have shown to be effective in management of symptoms, but it is important to note that there is not one diet that works for every child. Working with a specialized health care provider or registered dietitian can be helpful in choosing a diet therapy that works best for your child and lifestyle.  They can assess your child and create a plan to ensure your child receives adequate nutrition.

Some general tips to help with nutrition management include:

• Starting a journal to track symptoms and foods consumed to help identify a trend or pattern; Introducing – gradually – new foods into the diet;
• Offering smaller and more frequent meals that may be easier to tolerate;
• Limiting high fat or greasy/fried foods as they may exacerbate symptoms; and
• Striving to include foods from different food groups in the diet.

Lactose intolerance is more common in both IBS and IBD and it may be helpful to limit dairy in the diet. Due to the high risk of dehydration with both IBS and IBD secondary to chronic diarrhea, it is important to ensure adequate fluid intake.

Signs & Symptoms of IBS

Irritable bowel syndrome is defined as a chronic functional gastrointestinal disorder. While the functional changes associated with the syndrome are unclear and the exact cause is uncertain, there are many theories that can guide symptom management.

IBS symptoms can range from mild and easily manageable all the way to debilitating and out of control. This syndrome can also significantly impact quality of life. The range of symptoms may cause some confusion; however, there is a pattern to IBS symptoms. Symptoms typically occur during stress or following a large meal. One of the features that sets IBS apart from IBD is that it does not lead to inflammation and there is no long-term damage to the gastrointestinal tract with IBS.

Possible symptoms may include:

• Constipation
• Diarrhea
• Abdominal pain
• Stools with mucus
• Gas or bloating
• Frequent urgency to have a bowel movement
• Nausea

Proposed Cause of IBS

Although the exact cause of IBS is unknown, many theories exist for potential causes. One of the theories is the gastrointestinal tract is sensitive to gas and bloating. It is also thought that some are sensitive to changes in the bacteria in the gut, also known as the “microbiome”.

Studies have shown that it is common to have an overgrowth of bacteria in the small intestine (SIBO) in patients with IBS. Although there is a link between the overgrowth of bacteria and IBS symptoms, it may not be the only explanation for these symptoms.

Another theory relates to changes in levels of a chemical in the body called serotonin. Serotonin is responsible for regulating social behavior and mood; however, it also plays a role in motility – also known as movements or contractions – of the gastrointestinal tract and the sensation of needing to go to the bathroom.

Evidence also suggests a link between viral gastrointestinal infections and IBS. In fact, around one in every ten people with IBS suspect their IBS started after having an infectious illness. Lastly, stress has not been found to be a cause of IBS; however, it seems as though stress can aggravate IBS symptoms.

How is IBS Diagnosed?

If your child is showing persistent gastrointestinal symptoms, you may be referred to a gastroenterologist. The gastroenterologist will likely ask for a detailed medical history and perform a physical exam. The doctor may refer to criteria for diagnosing IBS known as the Rome criteria, which was developed by the Rome Foundation.  The Rome criteria states the patient will have recurrent abdominal pain on average a minimum of one day per week in the past three months and be associated with two or more of the following criteria:

• Related to defecation (discharging stool)
• Correlated with a change in frequency of stool
• Correlated with a change in stool form (appearance)

The gastroenterologist may also need to investigate further to rule out other gastrointestinal conditions. This may include stool samples, blood tests, imaging procedures (MRI or CT scan), or an endoscopic procedure (a long flexible tube with a camera at the end). There are inflammatory markers that are seen in IBD, but not in IBS.

What is IBD?

Inflammatory bowel disease is a disease that causes chronic inflammation in the gastrointestinal tract. In IBD, the body mistakes harmless substances as something that is harmful and reacts against these substances leading to inflammation. Crohn’s disease and Ulcerative Colitis are the two most common forms of IBD.

There are treatments to help control inflammation and minimize symptoms; although, there is not currently a cure for IBD. Children with IBD can go through times when the disease is active and they are experiencing symptoms, called a “flare”, as well as times of remission when there are no symptoms present.

Crohn’s disease can affect any part of the gastrointestinal tract and may even skip certain sections, while ulcerative colitis is limited to the colon (large intestine) and rectum. In a child with Crohn’s disease, the inflammation impacts the entire wall of the bowel and with ulcerative colitis, it only impacts the inner lining.

Symptoms may vary depending on which area is inflamed and this may also change over time. Symptoms may be similar to IBS in that it is common to have frequent or urgent stools. Diarrhea, abdominal pain and stomach cramping are also common. Symptoms that set IBD apart from IBS may include bloody stools and/or poor growth. Patients with IBD have also reported having fatigue and a decrease in appetite which may lead to weight loss. Malabsorption of nutrients may also contribute to weight loss and nutritional side effects.

What Causes IBD?

Much like IBS, the exact cause of IBD is unknown. Research indicates that many factors combined increase the risk for IBD. Possible factors that may lead to IBD include:

• Genetic risk factor
• Environmental factors
• Change or disturbance in the microbiome (bacteria in the intestines)
• Immune system has an inappropriate reaction

How is IBD diagnosed?

To diagnose IBD, the gastroenterologist may check both blood and stool tests to look for elevations in inflammatory markers. Anemia or iron deficiency is also common in IBD and would likely not be present in IBS. To confirm an IBD diagnosis, further investigation with an endoscopy (small flexible tube with a camera) and imaging with an MRI or CT may be needed. The gastroenterologist will look for signs of bleeding or ulcerations with an endoscopy and imaging can show if there is inflammation in the bowel.

How our Formulas May Help Your Child

Due to the increased risk of malabsorption or overall poor nutrient intake associated with many gastrointestinal conditions, an amino acid-based formula or elemental formula may be recommended to help support nutrient intake. EquaCare Jr. is a nutritionally complete formula for children over the age of one-years-old who may need a formula that is easier to digest at a more affordable cost. Essential Care Jr. offers the same broken-down proteins and increased amounts of more easily absorbed fats, but with a carbohydrate source that is low FODMAP and less likely to contribute to the uncomfortable digestive symptoms seen with other highly fermentable carbohydrates. For more information about our formulas, visit us at https://essentiallybetter.com/shop/

Sources:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051916/
• https://aboutibs.org/overview.html
• https://www.crohnscolitisfoundation.org/
• https://theromefoundation.org/rome-iv/rome-iv-criteria/