How to differentiate IBD from IBS in kids

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), as conditions that affect the gastrointestinal tract and cause significant discomfort or pain in the abdomen, can often get confused for one another among everyday people.

The truth is these two diagnoses differ greatly in terms of symptoms, causes, treatments and potential complications.

Dr. Joseph Runde, Lurie Children's gastroenterology, hepatology and nutrition physician, clarifies how the two conditions present and how to better identify them in children.

"IBD is an umbrella term for two main diagnoses: Crohn's disease and ulcerative colitis," Runde said. "In both conditions, we see damage, or inflammation, in the intestine caused by a person's own immune system. Patients with ulcerative colitis primarily have inflammation in the colon, or large intestine, while patients with Crohn's disease can have inflammation anywhere along the gastrointestinal tract."

With IBS, which may also be referred to as "functional gastrointestinal disorder" in children, inflammation will not be the underlying issue. Instead, IBS might present as crampy abdominal pain, nausea, vomiting, diarrhea and/or constipation. Research around what causes IBS is ongoing, but it may be driven in part by abnormal function of the intestine or by increased nervous system response.

Runde said some children may experience "very early onset" IBD, meaning they're diagnosed younger than 6 years old. "This group of children requires special consideration for links to immune deficiency and single gene defects that can result in inflammation to the intestine." This will likely require multidisciplinary care from immunology experts.

The most common symptoms of IBD include abdominal pain, diarrhea (with or without blood), urgency to use the restroom, rectal bleeding, anemia, fatigue and weight loss. Runde said another important sign that might indicate IBD in children can also be poor growth.

Runde added that sometimes children with IBD may also experience symptoms outside of their GI tract such as rashes, joint pain or swelling, inflammation of the eyes, ulcers in the mouth or around the bottom, liver disorders and osteoporosis.

On the other hand, those suffering from IBS/functional gastrointestinal disorder might experience abdominal pain or cramping, bloating, gas, nausea, vomiting, inconsistent bowel movement habits, and urgency to use the restroom after eating.

When it comes to diagnosing IBD, a thorough series of blood and stool tests, scopes, biopsies and imaging is required to make the diagnosis and personalize a treatment plan. At this time, there is no test that can confirm an IBS diagnosis. "This diagnosis is made based on history, physical examination and response to supportive strategies," Runde said.

"With IBD, treatment is personalized based on presentation, complications and severity and extent of inflammation," Runde said. "Your care team might explore different interventions such as long-term medical therapy, dietary therapy or surgical therapy to help get existing inflammation quiet and subsequently keep it quiet if possible. It's important to be proactive, as uncontrolled inflammation for long periods of time can result in more severe complications."

Runde says IBS management focuses more on support strategies such as lifestyle changes with routine, regular physical activity, dietary changes or restrictions, sleep hygiene, cognitive behavioral therapy (CBT) and sometimes medications, which can help with stomach relaxation, decreased intestinal spasm and others.

"In both cases, helping your child feel better is the goal. The sooner IBD or IBS is evaluated and diagnosed, the sooner we can take the next steps in getting them back to their baseline," he said.

Learn more about Lurie Children's Division of Gastroenterology, Hepatology and Nutrition at

• Children's health is a continuing series. This week's article is courtesy of Ann & Robert H. Lurie Children's Hospital of Chicago. For more information, visit

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