IBD in Remission but Symptoms Persist (Rome Foundation–IOIBD Consensus): Gastroenterology | September 2026

Introduction:

Up to one-third of patients with IBD report abdominal pain, altered bowel habits or bloating despite treatment, and approximately one-quarter remain symptomatic even in endoscopic or histologic remission. Distinguishing persistent inflammation from IBS-like symptoms is critical because misclassification may lead to unnecessary escalation of immunosuppressive therapy.

What Does the Consensus Recommend?

The preferred terminology is “IBD with IBS-like symptoms”—abdominal pain, bowel habit change and/or bloating that cannot be explained by active inflammation or structural disease.

Diagnosis should combine Rome symptom-based criteria with objective assessment for inflammation using biomarkers, endoscopy and/or imaging when appropriate.

Once active IBD and structural complications are excluded, management should target the residual symptoms rather than automatically intensifying IBD therapy.

Recommended options include:

Psyllium, provided there is no stricture

Short-term low-FODMAP diet

Symptom-directed pharmacological therapy

Neuromodulators when appropriate

Brain-gut behavioural therapies

Potential mechanisms include post-inflammatory visceral hypersensitivity, altered microbiota, epithelial barrier dysfunction, low-grade immune activation and bile acid disturbances.

Bottom Line:

Persistent GI symptoms in IBD do not necessarily mean persistent inflammation. Objective confirmation of disease activity should precede treatment escalation. When inflammation and structural disease are excluded, IBS-directed dietary, pharmacological and brain-gut therapies should become the focus of management.