|Miranda Lomer © ECCO
At least a third of patients with inactive IBD have coexisting functional bowel symptoms (e.g. abdominal pain, bloating, increased flatulence, diarrhoea and/or constipation) and these symptoms may be mistaken for active IBD. Patients may also experience increased anxiety/depression and reduced quality of life. Objective markers of disease activity (histological and inflammatory markers, e.g. faecal calprotectin, C-reactive protein), in conjunction with assessment of clinical symptoms, help to distinguish between functional bowel symptoms and active IBD. Identification of functional bowel symptoms in inactive IBD is important to avoid unnecessary and potentially harmful treatment strategies; on the other hand, active disease should be excluded before establishing that symptoms are functional in nature.