Increased Autoimmunity Burden Is a Risk Factor for Developing Irritable Bowel Syndrome-Like Symptoms in Quiescent Inflammatory Bowel Disease

BACKGROUND: A significant proportion of patients with inflammatory bowel disease (IBD) continue to experience gastrointestinal symptoms despite achieving endoscopic remission. These irritable bowel syndrome (IBS)-like symptoms may result from gut-brain axis dysfunction or low-grade immune activation. AIMS: We aimed to determine whether extra-intestinal autoimmune comorbidities are associated with IBS-like symptoms in quiescent IBD. METHODS: We conducted a retrospective cohort study of adult patients with IBD with endoscopic remission, excluding patients with prior IBS or less than 12 months of follow-up. The primary outcome was the development of IBS-like symptoms within 12 months of baseline colonoscopy. Multivariable Cox regression and Kaplan-Meier survival analysis were used to identify risk factors and assess time to symptom development. RESULTS: Among 399 patients, 80 (20.1%) developed new IBS-like symptoms within one year of achieving endoscopic remission. Mean time to symptom onset was 169.2 days (SD 110.3). Symptom development was significantly associated with extra-intestinal autoimmune comorbidities (HR 2.05; 95% CI 1.15-3.66; p = 0.015) and anxiety (HR 1.87; 95% CI 1.13-3.12; p = 0.016). Kaplan-Meier analysis showed that patients with autoimmune comorbidities had a significantly higher cumulative incidence of IBS-like symptoms compared to those without (log-rank p < 0.001). CONCLUSION: Among patients with IBD with endoscopic remission at baseline, 20.1% developed IBS-like symptoms within one year. The presence of autoimmune comorbidity was significantly associated with earlier development of IBS-like symptoms. These findings suggest that immune system dysregulation may play a role in persistent gastrointestinal symptoms and highlight the need for further research into the pathophysiology of IBS-like symptoms in quiescent IBD.