IBS vs IBD – Why the Right Diagnosis Matters

Jean Donet, MD, is a specialty care physician board-certified in gastroenterology and internal medicine at Inova Gastroenterology in Fairfax. Dr. Donet specializes in the evaluation and treatment of patients with Crohn’s disease and ulcerative colitis, as well as endoscopic procedures.

Pamela Stenborg, NP, is clinical nurse specialist and gastrointestinal nurse practitioner at Inova Gastroenterology in Fairfax.

Your bowels often determine how you feel – especially if your gastrointestinal (GI) tract is not functioning well. Digestive discomfort such as bloating, cramps and difficulty going to the bathroom can affect your diet, sleep, mood and overall health.

But before you assume you have irritable bowel syndrome (IBS) or that you can manage your symptoms with diet, you should dig a little deeper. GI distress that’s frequent or worsening is often a sign of a chronic condition. IBS is a chronic condition that causes GI symptoms, but it’s not the only one.

Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, can be confused with IBS. But the diagnosis, treatment and long-term prognosis are very different. The sooner you know your condition, the sooner you can get effective treatment and the tools you need to help you live comfortably.

At Inova Health System, we diagnose and treat all gastrointestinal issues and offer specialty care for complex conditions like IBD. We provide a range of treatment options, including medication and minimally invasive surgery, to find a fit for your diagnosis, symptoms and lifestyle.

How is IBD different from IBS?

Inflammation sets IBD apart from IBS – IBD involves inflammation, and IBS does not. Your immune system uses inflammation to protect your body. But chronic conditions can happen when your body produces too much inflammation.  

The autoimmune diseases that fall under the umbrella of IBD (Crohn’s disease and ulcerative colitis) involve inflammation that primarily impacts the intestines. But it can also affect other areas, including your joints, skin and eyes.

IBS is a syndrome – a collection of symptoms. It impacts your digestion and the way that food moves through your intestines. But the symptoms of IBS are typically contained within the gastrointestinal tract.

Recognizing the symptoms of IBD

The GI symptoms of IBD and IBS can be similar, making diagnosis challenging. Up to 20 percent of Crohn’s disease cases are mild and difficult to differentiate from IBS. That’s why IBD, especially Crohn’s disease, is often diagnosed later, after complications develop.

Symptoms common to both IBS and IBD include:

• Abdominal pain and cramping
• Bloating and gassiness
• Constipation
• Diarrhea
• Urgent bowel movements

But IBD symptoms often include more than digestive issues. The inflammation associated with IBD can cause additional symptoms, such as:

• Anemia (low iron)
• Bloody stool or bleeding from your rectum
• Eye inflammation
• Fatigue
• Joint pain
• Rashes
• Weight Loss

Diagnosing and treating IBS

IBS affects at least 10 percent of adults in the United States, but there’s no straightforward test to diagnose it. IBS requires a clinical diagnosis based on symptoms, health history and a physical exam. Your gastroenterologist may perform tests, imaging or procedures to rule out other digestive disorders.

IBS can affect your quality of life and requires lifelong attention, but it’s not destructive to your digestive tract like IBD. Treating IBS involves managing the symptoms and avoiding common triggers, including stress or certain foods.

Inova takes a multidisciplinary approach to IBS treatment, which may include:

• Dietary changes and recommendations to follow a specific diet to eliminate foods that trigger IBS symptoms
• Lifestyle changes to prioritize exercise and sleep can help relieve symptoms
• Medication, either to treat diarrhea and constipation or, in more severe cases, to stop intestinal spasms
• Psychological therapy and antidepressants because managing stress and mental health can decrease symptom flare-ups

Diagnosing and treating IBD

Inflammation associated with IBD is damaging to the intestines. Healthcare providers use tests, imaging and procedures to look for that damage. Putting the pieces together to distinguish one inflammatory bowel disease from another requires the skill and experience of a specialist.

Treating IBD is complex. While changing your diet may relieve some of the symptoms of IBD, diet alone is not typically enough to make IBD go into remission. IBD is not curable and when left untreated, it can lead to complications (often requiring surgery) and increase the risk of colorectal cancer and intestinal obstruction.

Treatment plans for IBD often include:

• Reducing inflammation by using anti-inflammatories, immunosuppressants, corticosteroids and biologic therapies
• Repairing damage and addressing complications through endoscopy and surgery when needed
• Managing digestive issues by incorporating individualized lifestyle and dietary changes under the guidance of a multidisciplinary team

Our gastroenterologists individualize treatment for IBD by considering a patient’s age, gender, health history, disease severity and lifestyle. They optimize medication – prescribing the proper doses and frequencies – to provide patients with the best quality of life. 

When to see a doctor for GI symptoms

If you notice GI symptoms that don’t go away or get worse, your first call should be to your primary care provider (PCP). They know you best, understand your health history and can run preliminary lab work to ensure you’re not anemic or have other systemic issues. When necessary, your PCP can refer you to an Inova gastroenterologist for specialized care.

If you have “red flag symptoms” such as blood in your stool, unexplained weight loss or severe abdominal pain, you should contact your primary care provider (PCP) or seek urgent care where they can evaluate you quickly. Then make an appointment to see a gastroenterologist, who can diagnose and treat you.

Schedule an appointment with an Inova gastroenterologist

Find out more about the full range of digestive system diseases and conditions the Inova GI team specializes in on our website. To schedule an appointment with your Inova gastroenterologist you can use your MyChart patient portal. If you do not have a gastroenterologist, we welcome you to contact us and make an appointment with a provider at any of our GI locations.