What is the significance of elevated erythrocyte sedimentation rate (ESR) in Inflammatory Bowel Disease (IBD) versus Irritable Bowel Syndrome (IBS)?

From the Guidelines

Elevated sedimentation rate (sed rate) is more commonly associated with inflammatory bowel disease (IBD) than irritable bowel syndrome (IBS), and its measurement can help differentiate between the two conditions, as suggested by the assessment of inflammatory markers like CRP 1. When evaluating sed rate elevation in patients with IBS or IBD, it's essential to consider the underlying pathophysiology of each condition. In IBS, sed rate is typically normal, as it's a functional disorder without significant inflammation. In contrast, IBD often shows elevated sed rates due to the underlying inflammatory process.

• The sed rate measures how quickly red blood cells settle in a test tube, which increases during inflammation, as noted in the context of monitoring Crohn's disease 1.
• For patients with IBD, sed rates may range from mildly elevated (20-50 mm/hr) to significantly high (>50 mm/hr) during disease flares, highlighting the need for routine laboratory and inflammatory marker assessments to establish a baseline value for future comparison 1.
• While an elevated sed rate can help support an IBD diagnosis or indicate active disease, it's not specific enough for diagnosis alone and must be considered alongside other clinical findings, imaging, and endoscopic evaluation.
• Other markers of inflammation, such as faecal calprotectin, can also be assessed to differentiate between intestinal inflammation and IBS, as recommended in the management of Crohn's disease 1.
• If you have an elevated sed rate and digestive symptoms, further testing is essential to distinguish between IBS and IBD, as their treatments differ significantly, and routine laboratory investigations, including complete blood count, liver profile, and vitamin B12, should be conducted to establish a comprehensive diagnosis 1.

From the Research

Sed Rate Elevation in IBS or IBD

• Sed rate elevation is a common indicator of inflammation in the body, and it can be elevated in both Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) [(2,3,4,5,6)].
• However, the provided studies do not directly address sed rate elevation in IBS, as they primarily focus on the management and treatment of IBD [(2,3,4,5,6)].
• In IBD, sed rate elevation can be an indicator of active inflammation, and it is often used as a marker to monitor disease activity and response to treatment [(2,3,4,5,6)].
• The studies suggest that IBD patients with elevated sed rates may require more aggressive treatment, including biologics, immunomodulators, and corticosteroids [(2,3,4,6)].
• It is essential to note that sed rate elevation can also be caused by other factors, such as infection, and it is crucial to rule out other potential causes before attributing it to IBD 5.

Key Findings

• IBD patients with elevated sed rates may require more aggressive treatment [(2,3,4,6)].
• Sed rate elevation can be an indicator of active inflammation in IBD [(2,3,4,5,6)].
• The provided studies do not directly address sed rate elevation in IBS [(2,3,4,5,6)].

Treatment Options

• Biologics, such as anti-TNF-α agents, may be used to treat IBD patients with elevated sed rates [(2,3,4,6)].
• Immunomodulators, such as azathioprine and methotrexate, may also be used to treat IBD patients with elevated sed rates [(2,3,4,6)].
• Corticosteroids may be used to induce remission in IBD patients with elevated sed rates [(2,3,4,6)].