Analyzing Therapeutic Interventions for IBS-Like Symptoms in Patients with Quiescent IBD
Existing literature doesn’t reveal benefits from gut-brain-targeted intervention strategies for the treatment of irritable bowel syndrome (IBS)-like symptoms in patients with quiescent inflammatory bowel...
Existing literature doesn’t reveal benefits from gut-brain-targeted intervention strategies for the treatment of irritable bowel syndrome (IBS)-like symptoms in patients with quiescent inflammatory bowel disease (IBD), according to a recent analysis of randomized controlled trials (RCTs).
Manjeet Kumar Goyal, MBBS, MD, DNB, DM , of Cleveland Clinic Akron General, and colleagues conducted the study and published their findings in Clinical Gastroenterology and Hepatology . Dr. Goyal and colleagues explained that up to one-third of patients with IBD in remission experience “persistent IBS-like symptoms,” exhibiting a “major unmet need not addressed by anti-inflammatory therapies.” The investigators examined the efficacy and use of dietary strategies and gut-brain-targeted interventions in this population “to quantify the therapeutic effects of these interventions.” They conducted a systematic search and meta-analysis of RCTs from databases including Embase, CENTRAL, Scopus, ClinicalTrials.gov, PubMed, and MEDLINE.
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Eligible RCTs included those that enrolled adult patients with quiescent IBD and symptoms similar to IBS through October 2025. The study team selected 13 RCTs encompassing 688 patients. The authors identified and analyzed interventions within the RCTs by class, including behavioral, pharmacologic, and dietary, among others.
Quality of life outcomes and the severity of patients’ symptoms were also separately measured within each intervention class, the study authors wrote. To analyze the data within the selected RCTs, Dr. Goyal and colleagues applied pooled standardized mean differences “using random-effects models with Hartung-Knapp adjustment” and they synthesized risk of bias and evidence certainty through RoB 2 and GRADE, respectively.
Among the selected RCTs, the “largest pooled symptom benefit” was observed with dietary interventions (SMD, −1.33; 95% CI, −4.42 to 1.77; I 2 =90%). However, investigators underscored the low level of evidence certainty with this symptom benefit, due to “heterogeneity and imprecision.” Behavior interventions showed smaller treatment benefits and also had low evidence certainty (SMD, −0.36; 95% CI, −0.82 to 0.10; I 2 =0%), and investigators highlighted limited evidence of symptom benefit with pharmacologic interventions due to “isolated, small trials.” Furthermore, the results demonstrated high risk of bias across RCTs (53.8%), “driven primarily by lack of blinding and subjective end points.” “Current evidence does not support a definitive benefit for any single intervention class in the management of IBS-like symptoms in quiescent IBD,” Dr.
Goyal and colleagues concluded. “Larger, rigorously designed blinded trials using standardized endpoints are needed to define effective symptom-directed therapies.” References Goyal MK, et al. Clin Gastroenterol Hepatol .
Published online September 25, 2026. doi: 10.1016/j.cgh.2026.09.022
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