Abdominal Pain in Inflammatory Bowel Diseases: A Clinical Challenge

Abstract

Up to 60% of inflammatory bowel disease (IBD) patients experience abdominal pain in their lifetime regardless of disease activity. Pain negatively affects different areas of daily life and particularly impacts the quality of life of IBD patients. This review provides a comprehensive overview of the multifactorial etiology implicated in the chronic abdominal pain of IBD patients including peripheral sensitization by inflammation, coexistent irritable bowel syndrome, visceral hypersensitivity, alteration of the brain-gut axis, and the multiple factors contributing to pain persistence. Despite the optimal management of intestinal inflammation, chronic abdominal pain can persist, and pharmacological and non-pharmacological approaches are necessary. Integrating psychological support in care models in IBD could decrease disease burden and health care costs. Consequently, a multidisciplinary approach similar to that used for other chronic pain conditions should be recommended.

Keywords: abdominal pain; inflammatory bowel disease; quality of life.

Figure 1

Proposed representation of mechanisms and multiple contributing factors implicated in abdominal pain in IBD: psychological and social factors, genetic factors, direct effect of inflammation, visceral hypersensitivity, co-existent IBS or central pain dysregulation. Abbreviations: IBS: irritable bowel syndrome; SIBO: Small intestinal bacterial overgrowth.

Figure 2

Proposed algorithm for pain management with pharmacological agents and non-pharmacological interventions available for improve chronic abdominal pain.