What are the key differences between IBS and IBD. How are these gastrointestinal conditions diagnosed and treated. What role do antibodies play in IBS diagnosis. Discover the answers in our in-depth analysis.

Understanding Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder affecting millions of Americans. It’s characterized by persistent abdominal pain, cramping, bloating, and changes in bowel habits. Unlike Inflammatory Bowel Disease (IBD), IBS doesn’t cause lasting harm to the bowels or increase cancer risk. However, it can significantly impact quality of life.

Types of IBS

• IBS-D: Diarrhea-predominant
• IBS-C: Constipation-predominant
• IBS-M: Mixed-type (alternating diarrhea and constipation)

What causes IBS? Food poisoning is a leading trigger, responsible for at least 60% of diarrheal IBS cases. The connection between food poisoning and IBS involves a toxin called Cytolethal Distending Toxin B (CdtB), released by common food-borne bacteria like Shigella, Campylobacter, Salmonella, and E. coli.

The CdtB Connection

When CdtB enters the body, the immune system produces anti-CdtB antibodies. Due to similarities between CdtB and vinculin (a protein crucial for gut function), the body may mistakenly produce anti-vinculin antibodies. This autoimmune response can lead to gut nerve damage and disruption of the gut microbiome, ultimately resulting in IBS symptoms.

Diagnosing Irritable Bowel Syndrome

Historically, IBS was diagnosed through exclusion, ruling out other conditions like IBD. However, modern diagnostic methods offer a more direct approach.

Antibody Blood Test for IBS

A doctor-ordered antibody blood test can now accurately diagnose IBS by measuring levels of anti-CdtB and anti-vinculin antibodies. These antibodies are typically elevated in patients with diarrheal IBS symptoms. If either antibody is elevated, a confident IBS diagnosis can be made.

Why is this test significant? It provides a more straightforward and less invasive method for diagnosing IBS, potentially reducing the need for extensive and costly diagnostic procedures.

Exploring Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease (IBD) is a chronic condition causing inflammation and sores in the gastrointestinal tract. Unlike IBS, IBD involves actual damage to the intestinal tissues.

Immune System Involvement

In IBD, the immune system mistakenly attacks food in the intestine, leading to inflammation and ulcerations in the bowel cells. This autoimmune response distinguishes IBD from IBS, which doesn’t involve tissue damage.

Types of IBD

1. Ulcerative Colitis: Inflammation in the large bowel or rectum
2. Crohn’s Disease: Inflammation or ulceration throughout the GI tract

Symptoms of IBD vs IBS

While IBS and IBD share some symptoms, IBD often presents with additional manifestations that aren’t typical of IBS.

Common IBD Symptoms

• Diarrhea
• Abdominal pain
• Rectal bleeding
• Joint pain
• Eye irritation
• Skin rashes
• Fever and fatigue
• Unintended weight loss

How do IBD symptoms differ from IBS? While both conditions can cause diarrhea and abdominal pain, IBD typically involves more severe systemic symptoms and visible bleeding, which are not characteristic of IBS.

Diagnostic Procedures for IBD

Diagnosing IBD often requires a combination of tests to assess the extent and location of inflammation in the gastrointestinal tract.

Common Diagnostic Tests for IBD

• Stool tests
• Blood tests
• Colonoscopy
• Endoscopy
• Imaging studies (CT scan, MRI)

Why are multiple tests often necessary? IBD can affect different parts of the digestive system, and various tests help pinpoint the location and severity of inflammation, guiding treatment decisions.

Treatment Approaches for IBS and IBD

While both IBS and IBD are chronic conditions, their treatment approaches differ significantly due to the underlying mechanisms of each disorder.

IBS Treatment Strategies

• Dietary modifications
• Stress management techniques
• Over-the-counter medications for symptom relief
• Prescription medications for severe cases
• Probiotics and gut microbiome support

What’s the primary goal of IBS treatment? The focus is on symptom management and improving quality of life, as IBS doesn’t cause permanent damage to the digestive system.

IBD Treatment Approaches

• Immunosuppressant medications
• Biologics
• Anti-inflammatory drugs
• Nutritional support
• Surgery in severe cases

Why is IBD treatment more intensive? The aim is to reduce inflammation, prevent complications, and induce remission of the disease to minimize long-term damage to the digestive tract.

Living with IBS vs IBD: Long-term Outlook

Both IBS and IBD are chronic conditions that require ongoing management, but their long-term impacts on health and quality of life can differ significantly.

IBS Long-term Outlook

IBS, while often frustrating and disruptive, doesn’t lead to serious complications or increase the risk of colorectal cancer. With proper management, many individuals with IBS can achieve significant symptom relief and maintain a good quality of life.

Can IBS symptoms change over time? Yes, the severity and nature of IBS symptoms can fluctuate, and some people may experience periods of remission.

IBD Long-term Outlook

IBD is a more serious condition that can lead to complications if not properly managed. These may include:

• Increased risk of colorectal cancer
• Malnutrition
• Bowel obstruction
• Fistulas or abscesses

However, with advances in treatment, many people with IBD can achieve long periods of remission and maintain a good quality of life. Regular monitoring and adherence to treatment plans are crucial for managing IBD effectively.

Emerging Research and Future Directions

The fields of IBS and IBD research are continually evolving, with new insights into disease mechanisms and potential treatments emerging regularly.

Promising Areas of IBS Research

• Gut microbiome modulation
• Targeted dietary interventions
• Novel pharmacological approaches
• Mind-gut connection therapies

What role might personalized medicine play in IBS treatment? As our understanding of individual variations in IBS improves, treatments may become more tailored to each person’s specific symptom profile and underlying triggers.

Advancements in IBD Research

• Gene therapy approaches
• Stem cell treatments
• Precision medicine strategies
• Gut microbiome manipulation

How might these advancements change IBD treatment? Future therapies may offer more targeted approaches with fewer side effects, potentially leading to better disease control and improved quality of life for IBD patients.

Lifestyle Considerations for IBS and IBD Management

While medical treatments play a crucial role in managing both IBS and IBD, lifestyle factors can significantly impact symptom severity and overall well-being for individuals with these conditions.

Dietary Strategies

For IBS:

• Low FODMAP diet
• Identification and avoidance of trigger foods
• Proper hydration
• Regular meal times

For IBD:

• Anti-inflammatory diets
• Adequate nutrient intake
• Avoidance of irritating foods during flares
• Consideration of elemental diets in severe cases

How can dietary changes impact symptoms? Proper nutrition can help manage symptoms, reduce inflammation, and support overall gut health in both IBS and IBD.

Stress Management

Stress can exacerbate symptoms in both IBS and IBD. Effective stress reduction techniques may include:

• Mindfulness meditation
• Regular exercise
• Adequate sleep
• Cognitive-behavioral therapy
• Relaxation techniques

Why is stress management crucial? The gut-brain connection plays a significant role in both conditions, and reducing stress can help alleviate symptoms and improve overall quality of life.

Support Networks

Living with a chronic gastrointestinal condition can be challenging. Building a strong support network can be beneficial for both IBS and IBD patients. This may include:

• Patient support groups
• Online communities
• Family and friend education
• Mental health professionals

How can support networks help? They provide emotional support, practical advice, and a sense of community, which can be invaluable in managing the day-to-day challenges of living with IBS or IBD.

Navigating Healthcare for IBS and IBD

Managing IBS or IBD often requires ongoing medical care and coordination between various healthcare providers. Understanding how to navigate the healthcare system effectively can lead to better outcomes and improved quality of life.

Building Your Healthcare Team

For IBS, your team might include:

• Primary care physician
• Gastroenterologist
• Dietitian
• Mental health professional

For IBD, your team may expand to include:

• IBD specialist
• Colorectal surgeon
• Rheumatologist (for associated joint issues)
• Dermatologist (for skin manifestations)

Why is a multidisciplinary approach important? Both IBS and IBD can affect multiple aspects of health, and a team approach ensures comprehensive care addressing all facets of the condition.

Tracking Symptoms and Treatments

Keeping detailed records of symptoms, triggers, and treatments can be invaluable for both IBS and IBD management. This may involve:

• Food and symptom diaries
• Medication logs
• Regular check-ins with healthcare providers
• Use of mobile apps for symptom tracking

How can symptom tracking improve care? It helps identify patterns, assess treatment effectiveness, and provides valuable information to your healthcare team for making informed decisions about your care.

Insurance and Financial Considerations

Managing chronic conditions like IBS and IBD can involve significant healthcare costs. Understanding your insurance coverage and available financial resources is crucial. Consider:

• Reviewing your insurance policy for covered treatments and procedures
• Exploring patient assistance programs for medications
• Investigating clinical trials for potential new treatments
• Discussing cost-effective treatment options with your healthcare team

How can you navigate the financial aspects of care? Open communication with your healthcare providers about financial concerns can help identify more affordable treatment options and resources for financial assistance.

The Role of Research and Clinical Trials

Ongoing research and clinical trials play a crucial role in advancing our understanding and treatment of both IBS and IBD. Participation in research can provide access to cutting-edge treatments and contribute to the broader knowledge base of these conditions.

Current Research Focus Areas

For IBS:

• Gut microbiome manipulation
• Novel pharmacological agents
• Psychological interventions
• Dietary strategies

For IBD:

• Targeted biologics
• Gene therapy approaches
• Stem cell treatments
• Gut-selective immunosuppressants

How might these research areas impact future treatments? They have the potential to lead to more effective, personalized therapies with fewer side effects, potentially improving outcomes for both IBS and IBD patients.

Participating in Clinical Trials

Individuals with IBS or IBD may consider participating in clinical trials. Benefits of participation can include:

• Access to new treatments before they’re widely available
• Closer monitoring of your condition
• Contributing to medical knowledge
• Potential for improved symptom management

What should you consider before joining a clinical trial? It’s important to discuss potential risks and benefits with your healthcare team, understand the trial protocol, and ensure you meet the eligibility criteria.

Staying Informed About Research Developments

Keeping up-to-date with the latest research can help you make informed decisions about your care. Ways to stay informed include:

• Following reputable patient advocacy organizations
• Subscribing to medical journals or their public-facing publications
• Discussing new developments with your healthcare team
• Attending patient education events or conferences

How can staying informed benefit you? It empowers you to have more productive conversations with your healthcare providers and make well-informed decisions about your treatment options.

IBS vs. IBD | Take Our Symptoms Quiz for IBS

Symptoms Quiz

Is It Really IBS?

Take a short quiz to find out if an antibody blood test for IBS is recommended for you.

Take Quiz

While irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) share some symptoms, they are completely different illnesses. 

Inflammatory Bowel Disease (IBD)

​

Inflammatory bowel disease (IBD) is a long-term health issue that causes swelling and sores in the gastrointestinal tract.

​

IBD causes your immune system to think that food in the intestine is not supposed to be there. The body then attacks the cells of the bowels, causing inflammation and ulcerations. 

There are two main types of inflammatory bowel disease (IBD): ulcerative colitis and Crohn’s disease. 

Symptoms of IBD, like symptoms of IBS, include diarrhea and abdominal pain; however, in addition to these, IBD symptoms also include rectal bleeding, joint pain, eye irritation, and rashes.  

While there is currently no known cure for IBD, there are various immunosuppressants to help manage the symptoms of IBD.

​

Here is an excellent patient guide to IBD published by the American Gastroenterological Society in Clinical Gastroenterology and Hepatology.

View Study

How Do You Diagnose

Inflammatory Bowel Disease (IBD)?

​

There are various ways your doctor might want to test for IBD. Diagnostic procedures might include stool tests, blood tests, and often more invasive endoscopic procedures like a colonoscopy. 

Your doctor will want to know where in your body the inflammation is occurring and will want to get a clear understanding of the state of your gastrointestinal tract. 

There are two types of IBD that can be diagnosed. Crohn’s disease is inflammation or ulceration located throughout the GI tract, and ulcerative colitis is inflammation found in the large bowel or rectum. 

Both types of IBD have their own symptoms that guide your doctor towards the most appropriate tests.

Ulcerative Colitis

• Diarrhea

• Fever & fatigue

• Abdominal pain and cramping

• Blood in your stool

• Reduced appetite

• Unintended weight loss

• Red, swollen eyes

Crohn’s Disease 

• Cramps/belly pain (often in the lower right side)

• Diarrhea

• Weight loss

• Bleeding

• Skin rash

• Arthritis (painful, swollen joints)

• Fatigue

Irritable Bowel Syndrome (IBS)

​

Irritable bowel syndrome, or IBS, is a health issue found in your intestines. It causes persistent abdominal pain, cramping, gas, bloating, and change in stool – some combination of chronic diarrhea and constipation. If you are suffering from these symptoms, you’re not alone. Nearly 40 million Americans suffer from IBS. 

​

There are three types of IBS: diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), and mixed-type (IBS-M, where diarrhea and constipation both persist). IBS does not cause lasting harm to the bowels and does not lead to cancer; however, it can severely impair you physically and emotionally. 

​

Food poisoning is the leading known cause of IBS, accounting for at least 60% of all diarrheal IBS cases. The path from food poisoning to IBS has to do with a toxin called Cytolethal Distending Toxin B, or CdtB for short. The most common bacteria that cause food poisoning like Shigella, Campylobacter, Salmonella, and E. coli. release the toxin CdtB into your body. 

When a toxin like CdtB enters your body, your immune system fights back with an antibody – in this case, your body creates anti-CdtB. CdtB looks in some ways like vinculin, a naturally occurring protein in your body that is critical in healthy gut function. Because CdtB and vinculin can look alike, your body can think it needs to fight back against vinculin, at which point it starts producing another antibody, anti-vinculin. 

The production of anti-vinculin is an autoimmune response and leads to gut nerve damage and improper functioning of the Interstitial Cells of Cajal (ICC) and Migrating Motor Complexes (MMC). When these do not function properly, your gut microbiome is disrupted. Your gut microbiome is composed of billions of bacteria in your gut that, when balanced, keep your gut healthy.

This disruption ultimately results in irritable bowel syndrome (IBS).

Here is an excellent patient guide to IBS published by the American Gastroenterological Society​.

View Study

How Do You Diagnose Irritable

Bowel Syndrome (IBS)?

Traditionally, IBS was an exclusionary diagnosis, meaning other diseases – especially IBD – had to be ruled out in order to diagnose IBS. Alternatively, an antibody blood test can diagnose IBS more directly. 

Irritable bowel syndrome can be accurately ruled in with a simple, doctor-ordered antibody blood test.  The test measures the levels of two antibodies, anti-CdtB and anti-vinculin, known to be elevated in the blood of the majority of patients experiencing IBS with diarrheal symptoms. If either antibody is elevated, a confident IBS diagnosis can be made.  

A positive result on the test also indicates that the root cause of your IBS was an instance of food poisoning (gastroenteritis) that has led to a disruption in your gut microbiome. This can guide your healthcare provider to therapies that treat your microbiome, like FDA-approved antibiotics and low-fermentation diets. 

If your antibody blood test result is not positive, your doctor may want to conduct other tests to diagnose your symptoms.

The American College of Gastroenterology’s Clinical Guidelines for the Management of IBS suggest “a positive diagnostic strategy” (ruling in IBS) as compared to “a diagnostic strategy of exclusion” (ruling out other diseases) “…to improve time to initiate appropriate therapy….and to improve cost-effectiveness.”

View Study

What Is ibs-smart?

ibs-smart is the only licensed, patented test that can measure validated biomarkers, anti-CdtB and anti-vinculin,  in your blood that indicate IBS with 96% – 100% positive predictive value. Further, the test is over 90% specific in differentiating IBS from other diarrheal diseases like IBD. While IBS and IBD can co-exist, IBD itself does not lead to the elevation of these antibody biomarkers.

By accurately diagnosing your IBS and identifying the cause (a microbiome disruption caused by an infection), ibs-smart™ can expedite your path to treatment and prevent years of potentially unnecessary procedures like colonoscopies.

You can order ibs-smart without an appointment online through our online prescriber service or download a patient-doctor discussion guide to take to your next doctor’s appointment.

​

Order ibs-smart

Order ibs-smart Online.

No appointment necessary

You can work with a doctor online to order ibs-smart, if it’s right for you.

The online prescriber service includes:

​

• A symptoms evaluation by a doctor

• Clear and actionable results emailed directly to you

• Post-test results consultation by phone with a doctor

Play Video

Facebook

Twitter

Pinterest

Tumblr

Copy Link

Link Copied

Get Started

Prefer to work with your healthcare provider instead? Download the ibs-smart discussion guide and educational materials here.  

Post-Infectious IBS

A significant volume of research shows a clear link between food poisoning

and irritable bowel

syndrome (IBS).

Read More

Diarrhea & IBS

Chronic diarrhea can indicate disorders, such as inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS).

Read More

SIBO & IBS

While what causes SIBO is an excess of bacteria, there are many conditions that can lead to SIBO like irritable bowel syndrome.

Read More

Do I Have Crohn’s disease or IBS? A Quiz to Help Understand Your Symptoms

‍Irritable bowel syndrome (IBS) and Crohn’s disease may share some of the same symptoms, but they are two very different health conditions. Crohn’s disease is one of two conditions under inflammatory bowel disease (IBD), a potentially serious condition that impacts the structure of the bowel.

In contrast, IBS is classified as a functional gastrointestinal disorder, meaning there are changes in the function of the GI tract that cause symptoms, but you won’t see structural changes or abnormalities on a blood test.

Anytime you notice changes in your digestive health, visiting a healthcare provider is essential. Both IBS and Crohn’s disease impact the gut, but the diagnosis and treatment of each condition vary. 

Understanding the key differences between IBS and Crohn’s disease can help you get the proper support and care for your needs.

IBS vs Crohn’s Disease

At first glance, it may be hard to differentiate IBS from Crohn’s disease. Aside from both being gastrointestinal disorders, they can share many of the same symptoms. Both conditions can also significantly impact your quality of life. 

The most noticeable difference between the two disorders is that while IBS is a functional disorder, Crohn’s disease is a chronic inflammatory disease related to autoimmunity. An autoimmune disease means the immune system mistakes healthy tissue for a foreign invader, so immune cells attack tissues and can cause long-term damage. 

Having IBS doesn’t mean you’ll develop Crohn’s or vice versa—they are two separate disorders. Let’s take a closer look at each in more detail.

What Is Crohn’s Disease?

Crohn’s disease is a chronic condition that causes inflammation along the GI tract anywhere from the mouth to the anus. The exact cause isn’t known, but it’s likely a combination of genetics, immune dysfunction, and environmental exposures.

People with Crohn’s may experience episodes of remission and relapse, with cases ranging from mild to severe. Over time inflammation in the bowel wall can cause fistulas, bowel obstructions, strictures, and eventually surgery.

Symptoms of Crohn’s Disease

Symptoms of Crohn’s disease can include:

• Abdominal pain, especially in the right lower belly.
• Weight loss.
• Diarrhea.
• Bleeding or mucus in stools.
• Fatigue.
• Gas and bloating.
• Anemia.

Crohn’s disease can also include extraintestinal symptoms, which occur outside of the digestive system. These include eye inflammation, swelling and sores in the mouth, and arthritis (painful, swollen joints).  

Diagnosis and Treatment of Crohn’s Disease

If you have symptoms of IBD or Crohn’s, your doctor will likely recommend a comprehensive work-up, including blood tests, stool tests, endoscopy, and colonoscopy, to confirm and examine any structural changes or inflammation in the intestines. 

Fecal calprotectin, a test specifically used for IBD, and inflammatory markers like C-reactive protein (CRP) or Erythrocyte sedimentation rate (ESR)  are often used to differentiate between IBS and Crohn’s and monitor disease activity.

‍Treatment for Crohn’s depends on the severity and progression of the disease but will usually include a combination of medications, including steroids or biologics to suppress the immune system, plus lifestyle changes. 

Diet is essential to support the health of the digestive tract and address inflammation. Certain foods or textures can trigger symptoms or irritate the lining of the intestines, especially during a flare. Undernutrition is a concern for people with Crohn’s.  

Nourish offers one-on-one counseling for people with Crohn’s and accepts the most popular insurance carriers. If you need support, consider booking a virtual appointment with a registered dietitian.

What is IBS?

Irritable bowel syndrome is considered a gut-brain disorder because the brain and nervous system can affect the health and function of the digestive tract.

While not as severe as Crohn’s disease in terms of inflammation, IBS can still cause considerable discomfort. It’s also extremely common, affecting 5 to 10% of the population worldwide.

There are four categories of IBS, according to the American College of Gastroenterology (ACG):

• IBS-C: Constipation predominant.
• IBS-D: Diarrhea predominant.
• IBS-M: Alternating constipation and diarrhea.
• IBS-U: Meets the criteria for IBS, but stool consistency (loose or hard) doesn’t fall into the expected pattern of the categories.

Women are more likely to be diagnosed with IBS. Prevalence also appears to decrease with age, with 25% fewer people diagnosed after age 50. There’s no single cause of IBS, but likely related to factors such as alterations in gut motility, brain-gut interactions, stress, history of food poisoning, and genetic predisposition. 

IBS may have a relationship to alterations in the gut immune system, meaning it involves the immune cells and causes inflammation, but it’s not an autoimmune process that causes tissue damage, as seen with Crohn’s. It often appears with other health conditions, especially anxiety and depression. 

Symptoms of IBS

‍Symptoms of IBS vary from mild to severe and can include:

• Abdominal pain.
• Constipation, diarrhea, or both.
• Bloating and gas.
• Nausea.
• Changes in appetite.

Diagnosis and Treatment of IBS

Diagnosis for IBS includes reviewing medical history and an exam to check for underlying conditions like IBD or celiac disease.  

The Rome IV criteria, a set of criteria that people with IBS must meet for diagnosis, state that people with IBS should report recurrent abdominal pain at least once a week in the last three months associated with at least 2 of the following:

• Pain related to bowel movements.
• Change in frequency of stool.
• Change in stool form (appearance) of stool.

Like Crohn’s, treatment for IBS depends on severity. Lifestyle changes addressing diet, sleep, and stress are often enough to manage IBS symptoms. Medications may help with severe symptoms, but immunosuppressants aren’t necessary. 

Diet can play a significant role in addressing and managing IBS. Studies suggest that working with a registered dietitian to assess for gaps in nutrition and develop and guide people with IBS through elimination diets can significantly help with quality of life and lowering symptoms.

One of the most common patterns used for IBS is the low FODMAP diet. FODMAP stands for fermentable oligo-, di-, mono-saccharides, and polyols, short-chain carbohydrates found in many foods. Some people find these carbohydrates difficult to digest, causing gas, bloating, and other symptoms.

The low FODMAP is not meant to be a long-term diet because it can be overly restrictive. Working with a dietitian can help you customize the elimination and reintroduction phases to meet your needs.

8 Questions to Help Identify If You Have Crohn’s Disease or IBS

You can use the following questions to identify patterns and guide your conversation with your doctor. These results are only a starting point and not a replacement for medical advice.

Consider the following questions:

1. Have you experienced ongoing abdominal pain and discomfort at least once a week over the past three months?
2. Do you alternate between constipation and diarrhea?
3. Do your symptoms improve after having a bowel movement?
4. Do you experience anxiety or depression?
5. Are you prone to developing mouth sores or ulcers? 
6. Do you experience fatigue or weakness?
7. Do you have unexpected weight loss?
8. Do you experience rectal bleeding or blood in your stools?

Interpreting Your Results

If you answered “yes” to questions one through four, IBS could be a possibility to discuss with your doctor.