IBS vs IBD: Gastroenterologist shares the main differences between the two common gut conditions

Expert unpacks the common symptoms of IBS and IBD, elaborating on the treatments and when to seek medical help.

Gut health is getting spotlighted in wellness conversations today, and for all the right reasons. Because of the growing discourse around it, there are a lot of remedies and superfoods for common, upset gut issues like bloating, acid reflux, or diarrhoea. But what if these gut issues are actually signs of underlying health conditions that require medical intervention, not just your go-to gut superfoods? IBS and IBD typically share very similar symptoms and may even be confused with everyday digestive issues like bloating, which commonly happens after a heavy meal. It's common to brush them off as minor issues, but they can also hint at IBS and IBD.

Bloating, abdominal pain may be common gut issues, but sometimes they can also be serious. (Shutterstock)

In an interview with HT Lifestyle, Dr Anukalp Prakash, Director of Gastroenterology at CK Birla, Gurugram, shared the key differences between IBS, IBD, and their symptoms, diagnosis and treatments.

He explained the basics, addressing the confusing overlap of symptoms, “The spread of digestive health problems is on the rise, and two conditions frequently mentioned in such a context are IBS (Irritable Bowel Syndrome) and IBD (Inflammatory Bowel Disease). Even though the two share a common set of symptoms and both involve the gastrointestinal (GI) tract, they are quite distinct in causes, implications, and treatment approaches. Understanding the difference is key to effective management and future well-being. Both IBS and IBD benefit from early diagnosis to be treated most effectively and with the best long-term prognosis.”

Dr Anukalp Prakash shared a detailed guide with HT Lifestyle, distinguishing the key differences between IBS and IBD, along with treatment pathways:

What is IBS?

IBS symptoms include diarrhoea or constipation. (Shutterstock)

• Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder, i.e., the digestive system looks normal on exams but doesn't work as well as it should.
• It includes issues with how the gut and brain coordinate with each other, usually causing increased gut sensitivity and alterations in the way food is moved through the digestive system. IBS does not lead to inflammation or injury that one can see in the gut. But it can have a huge impact on one's quality of life.
• Symptoms: Some of the most common symptoms are pain in the abdomen, bloating, gas, diarrhoea, constipation, or a combination of these. The symptoms are usually changing and can be influenced by stress, hormones, or food.

What is IBD?

IBS symptoms include abdominal pain, fever, and weight loss. (Shutterstock)

• Inflammatory Bowel Disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract.
• Two forms: The two major forms are Crohn's disease, which can affect any region of the GI tract, and Ulcerative colitis, which classically involves the colon and rectum.
• Main difference: In contrast to IBS, IBD is a condition with true damage to the lining of the intestine due to an excessive immune response. This causes inflammation, ulcers, and chronic complications in the form of strictures, fistulas, malnutrition, or even a higher risk of colorectal cancer.
• Symptoms: They may consist of abdominal pain, diarrhoea (occasionally with blood), weight loss, fatigue, and fever. Symptoms might recur in flare-ups interspersed with phases of remission.
  

Key differences of IBS and IBD at a glance

Feature	IBS	IBD
Type of Condition	Functional disorder	Inflammatory disease
Inflammation	No	Yes
Damage to GI Tract	None	Yes, sometimes severe
Blood in Stool	Not typical	Common
Weight Loss & Fever	Uncommon	Common
Risk of Complications	Low	High
Treatment Focus	Symptom control	Inflammation control and immune management

How are they diagnosed?

• IBS: IBS is usually diagnosed on the basis of symptom criteria (e.g., the Rome IV criteria) and exclusion of other disorders. Blood work, imaging, and endoscopy are typically normal in IBS patients.
• IBD: IBD needs more prolonged testing. Diagnosis can involve blood tests, stool testing (e.g., for inflammatory markers such as faecal calprotectin), colonoscopy with biopsies, and imaging procedures such as CT or MRI. These tests are used to determine and measure the extent of inflammation and tissue damage.
  

How are IBS and IBD treated?

• IBS: For IBS, symptom relief and enhancement of functional status are the goals of treatment. For many, this involves dietary modifications (e.g., a low FODMAP diet), fibre supplementation, medications for diarrhoea or constipation, and stress management. For others, psychological treatments such as CBT are helpful.
• IBD: Conversely, treatment for IBD aims to decrease inflammation and manage the immune system. Treatment may include anti-inflammatory medication (e.g., aminosalicylates), corticosteroids, immunosuppressive drugs, and biologic agents. Surgery may be needed for more extreme cases to eliminate affected areas of the gut.

When to seek medical advice for IBS and IBD?

• Common symptoms but different causes: Though IBS and IBD share similar symptoms, e.g., abdominal discomfort and alterations in bowel movements, their causes and health concerns are quite different.
• IBS is irritating and long-lasting but does not injure the intestines or contribute to other significant health issues.
• IBD, however, is a severe autoimmune disease that has the potential to cause long-term harm and requires precise control.
• When to go see a doc: If one has persistent digestive symptoms, particularly if they involve blood in the stool, unintended weight loss, persistent fatigue, or nighttime symptoms that disturb your sleep, it is crucial to see a gastroenterologist.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.