Research shows that people with inflammatory bowel disease in remission often experience IBS-like symptoms including stomach pain, bloating, and irregular bowel movements. According to Gram Research analysis, a 2026 consensus of 13 international digestive experts endorsed 86 treatment recommendations for this condition, including fiber supplements, a low FODMAP diet, targeted medications, and mind-body therapies—providing doctors with standardized guidelines for the first time to properly diagnose and treat these overlapping symptoms without over-medicating.
Millions of people with inflammatory bowel disease (IBD) feel better when their condition is under control, but still experience stomach pain, bloating, and irregular bowel movements that look like irritable bowel syndrome (IBS). This confusion makes it hard for doctors to know the right treatment. According to Gram Research analysis, a team of international experts created the first official guidelines to help doctors understand and treat these overlapping symptoms. The new recommendations provide clear definitions, testing strategies, and treatment options—from diet changes to therapy—to help patients get better care and avoid unnecessary medications.
Key Statistics
A 2026 consensus of 13 international digestive experts reviewed 105 treatment recommendations for IBD patients with IBS-like symptoms and rated 86 as appropriate, 16 as uncertain, and only 3 as inappropriate, according to research published in Gastroenterology.
The consensus panel endorsed psyllium fiber, short-term low FODMAP diet, targeted medications, and brain-gut behavioral therapies as appropriate treatments for IBD with IBS-like symptoms, providing the first standardized treatment guidance for this condition.
The expert panel defined ‘IBD with IBS-like symptoms’ as abdominal pain, bowel habit changes, and/or bloating not explained by active inflammation or structural disease, establishing clear terminology to reduce diagnostic confusion.
The Quick Take
- What they studied: How to identify and treat stomach pain and bowel problems in people with IBD whose disease is in remission but who still have IBS-like symptoms
- Who participated: A panel of 13 international digestive disease experts from the Rome Foundation and the International Organization for the Study of IBD who reviewed medical research and voted on treatment recommendations
- Key finding: Of 105 treatment recommendations reviewed, 86 were rated as appropriate, including fiber supplements, a low FODMAP diet, specific medications, and mind-body therapies—providing doctors with clear guidance for the first time
- What it means for you: If you have IBD and still experience stomach symptoms even when your disease is controlled, doctors now have standardized guidelines to properly diagnose your condition and choose the right treatment without over-treating your IBD
The Research Details
This was a consensus-building project, not a traditional research study. Thirteen expert doctors from around the world reviewed all the published scientific evidence about IBD patients with IBS-like symptoms. They then created statements about how to diagnose and treat this condition. Each expert independently rated whether each statement was appropriate, using a scale from 1 to 9. After the first round of voting, the experts discussed their reasons and voted again. This two-step process helped them reach agreement on the best practices.
The team looked at five main areas: what to call this condition, how to diagnose it, what dietary changes help, which medications work, and how mind-body therapies can help. They reviewed 133 possible recommendations and narrowed them down to 105 for final voting.
This approach is valuable because it combines expert knowledge with scientific evidence to create practical guidelines that doctors can actually use in their offices. Rather than relying on one study, the consensus method pulls together the best thinking from leading specialists worldwide.
Before these guidelines, doctors didn’t have a standard way to talk about or treat IBD patients with IBS-like symptoms. This led to confusion, inconsistent care, and sometimes patients receiving stronger IBD medications when they didn’t actually need them. Having clear, agreed-upon definitions and treatment strategies means patients get the right diagnosis and the right treatment the first time.
This consensus was developed by leading international experts in digestive diseases, published in a top medical journal (Gastroenterology), and used a rigorous voting process to ensure agreement. The recommendations are based on systematic reviews of published research. However, this is a consensus document, not new research data, so it reflects expert opinion guided by evidence rather than new experimental findings.
What the Results Show
The expert panel agreed on a clear definition: “IBD with IBS-like symptoms” means stomach pain, changes in bowel habits, and/or bloating that cannot be explained by active inflammation or structural problems in the gut. This definition helps doctors distinguish between active IBD that needs stronger treatment and IBS-like symptoms that need different approaches.
For diagnosis, the panel recommended combining Rome clinical criteria (a standard checklist of symptoms) with objective tests to confirm there’s no active inflammation. These tests include endoscopy (looking inside the gut), biopsies (tissue samples), blood and stool biomarkers (chemical markers of inflammation), and imaging studies.
For treatment, the panel endorsed several approaches: psyllium fiber (a natural supplement), a short-term low FODMAP diet (avoiding certain carbohydrates that can cause bloating), targeted medications, and brain-gut behavioral therapies (like cognitive behavioral therapy or gut-directed hypnotherapy). The panel rated 86 of 105 recommendations as appropriate, with 16 marked as uncertain and only 3 deemed inappropriate.
The consensus also provided specific guidance on when to use each treatment and how to monitor whether it’s working. This gives doctors a clear roadmap instead of guessing what might help.
The panel emphasized that diagnosis should combine clinical symptoms with objective evidence of remission—meaning doctors shouldn’t rely on symptoms alone. They also endorsed specific thresholds for what counts as remission in endoscopy, biopsies, biomarkers, and imaging, which will help standardize research studies going forward. The recommendations highlighted that brain-gut behavioral therapies are appropriate treatments, recognizing the important connection between the mind and digestive symptoms.
This is the first joint consensus from the Rome Foundation and the International Organization for the Study of IBD on this topic. Previously, doctors had to piece together guidance from separate IBD and IBS literature, which sometimes contradicted each other. These new recommendations integrate both perspectives and represent the most current expert thinking on managing this overlapping condition.
This is a consensus document based on expert opinion, not new research data. The recommendations are only as strong as the underlying evidence reviewed, and some areas had limited research available (those were marked as uncertain). The panel size was small (13 experts), though they were internationally diverse. The recommendations will need to be tested in real clinical practice to confirm they work as intended. Additionally, the consensus reflects current knowledge, which may change as new research emerges.
The Bottom Line
If you have IBD and experience ongoing stomach pain, bloating, or irregular bowel movements even when your disease is controlled, ask your doctor about these evidence-based approaches: (1) Psyllium fiber supplements (unless you have strictures/narrowing), rated as appropriate with high confidence; (2) A short-term low FODMAP diet, rated as appropriate with high confidence; (3) Targeted medications based on your specific symptoms, rated as appropriate; (4) Mind-body therapies like cognitive behavioral therapy or gut-directed hypnotherapy, rated as appropriate. Start with testing to confirm your IBD is truly in remission before starting these treatments.
These recommendations are most relevant for people with IBD (Crohn’s disease or ulcerative colitis) whose disease is in remission but who still have IBS-like symptoms. They’re also important for gastroenterologists, primary care doctors, and other healthcare providers treating IBD patients. People with active IBD inflammation should not use these guidelines—they need different treatment. People with IBS alone (without IBD) should consult separate IBS guidelines.
Dietary changes like the low FODMAP diet may show benefits within 2-4 weeks. Fiber supplements typically take 1-2 weeks to show effects. Mind-body therapies usually require 8-12 weeks of regular practice to see meaningful improvement. Medications vary depending on which drug is used. Most people should see some improvement within 4-8 weeks if the right treatment is chosen, though it may take longer to find the optimal approach.
Frequently Asked Questions
What’s the difference between IBD flare-ups and IBS-like symptoms in people with IBD?
IBD flare-ups involve active inflammation visible on endoscopy or in blood tests, requiring stronger medications. IBS-like symptoms in remission include pain and bowel changes without active inflammation, treated with diet, fiber, and mind-body therapies instead.
Can I use the low FODMAP diet if I have inflammatory bowel disease?
Yes, the 2026 expert consensus recommends a short-term low FODMAP diet as appropriate for IBD patients with IBS-like symptoms. However, use it temporarily and work with your doctor, as long-term restriction may affect nutrition in IBD patients.
Are mind-body therapies like meditation actually helpful for stomach problems from IBD?
The international expert consensus rated brain-gut behavioral therapies (including cognitive behavioral therapy and gut-directed hypnotherapy) as appropriate treatments for IBD with IBS-like symptoms, recognizing the strong mind-gut connection.
How do doctors tell if my stomach pain is from active IBD or just IBS-like symptoms?
Doctors combine symptom checklists with objective tests: endoscopy, biopsies, blood/stool biomarkers, and imaging to confirm remission. If inflammation is absent, symptoms are likely IBS-like and need different treatment than active IBD.
What should I do if these treatments don’t help my IBS-like symptoms?
Give treatments 6-8 weeks to work while tracking symptoms. If no improvement, tell your doctor—they may adjust your approach, try different medications, or refer you to a specialist in brain-gut therapies or dietary management.
Want to Apply This Research?
- Log daily abdominal pain (0-10 scale), bowel movement frequency and consistency (using the Bristol Stool Chart), and bloating severity (0-10 scale) to track whether your chosen treatment is working over 4-8 weeks
- If starting a low FODMAP diet, use the app to track which foods trigger your symptoms and identify your personal food triggers within the low FODMAP framework; set reminders for fiber supplements at the same time daily; schedule and log mind-body therapy sessions (meditation, breathing exercises, or CBT practices)
- Create a weekly symptom summary comparing your baseline (before treatment) to current symptoms; set monthly check-in reminders to assess whether your chosen treatment is working; if symptoms don’t improve in 6-8 weeks, flag this for your doctor to consider adjusting the treatment plan
This article summarizes expert consensus recommendations and should not replace professional medical advice. If you have inflammatory bowel disease and experience ongoing symptoms, consult your gastroenterologist or healthcare provider before starting any new diet, supplement, or treatment. These recommendations apply only to IBD patients in remission with IBS-like symptoms—not to people with active IBD inflammation or IBS alone. Individual treatment plans should be personalized based on your specific condition, medical history, and test results.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.