Patients with ulcerative colitis (UC) report experiencing irritable bowel syndrome (IBS)–like symptoms despite being properly medicated and in remission, according to survey results presented at the European Crohn’s and Colitis Organization 2025 meeting. Irritable bowel syndrome occurs more often in people who have IBD than in those who do not, noted Darcy Ayton and Sami Hoque, MD, PhD, a gastroenterologist. “Patients with ulcerative colitis (UC) frequently report symptoms such as abdominal discomfort, bloating, altered bowel habits, and worsening symptoms due to foods or stress, even during clinical remission,” the researchers wrote in the Journal of Crohn’s and Colitis, where the results were also published. This study examines the prevalence of IBS-like symptoms in patients with UC at an IBD clinic in a London teaching hospital.

Ayton and Dr. Hoque conducted a survey of 100 patients with UC, 66% of whom were in remission. Nearly all patients (91%) had their disease managed with medication. The researchers collected data on patients’ age, gender, disease location, current treatment, year of diagnosis, and total symptom scores. Remission was defined with three criteria: fecal calprotectin levels of no more than 250 μg/g in the last year, a Mayo score of zero based on a flexible sigmoidoscopy/colonoscopy within the previous six months, and C-reactive protein levels within the normal range in the last six months. The researchers based their 16-question survey on WHO criteria.

Ayton and Dr. Hoque found that patients with active disease had significantly more symptoms than those whose disease was in remission (P=0.007). Even so, virtually all survey participants (94%) reported experiencing one or no IBS-like symptoms. Overall, the average total symptom score was 11.32 (SD ~6.08), which indicates “persistent symptoms,” according to the researchers. There was also a “preponderance” of higher symptom scores in women with UC compared with men. In terms of active disease, women had an average symptom score of 16.67 (SD 5.91) compared with 11.53 (SD 5.66) in men. In remission, women still had higher symptom scores, with a mean of 11.77 (SD 5.96) versus 9.59 (SD 5.56) for men. This difference was statistically significant for patients with active disease (P=0.014), but not for those in remission.

Among the 66 patients in remission, the most common symptoms or problems reported as occurring “all or most of the time” included symptoms that worsened with stress or anxiety (53%), avoiding specific foods (34.8%), and symptoms worsening with certain foods (31.8%). The most common symptoms occurring some of the time were loose stools (48.5%), flatulence (41.8%), and bloating (40.9%). The researchers also described correlations between symptoms among patients in remission. Bloating correlated with reported constipation (r=0.32; P=0.008), possibly indicative of proximal constipation, and loose stools were strongly correlated with bowel urgency (r=0.73; P<0.001), suggesting a symptom cluster. For patients in remission, proctitis was associated with the highest scores, whereas pancolitis was associated with the lowest. Disease location and time since diagnosis were weakly negatively correlated with symptom scores.

“This study shows that IBS-like symptoms persist in patients with UC during remission, with 94% reporting one or more symptoms despite active drug management,” Ayton and Dr. Hoque wrote. “Symptom clusters such as loose stools and bowel urgency and gender differences emphasize the need for tailored, symptom-focused care. Comprehensive strategies are essential to address residual symptoms and improve quality of life for patients with UC, even in remission.”