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Around one-third of individuals with IBD experience persistent gastrointestinal symptoms similar to irritable bowel syndrome (IBS) in the absence of objective evidence of disease activity.  Despite enduring the side-effects of long-term therapies, this cohort has a quality of life that is not significantly different to that of individuals with uncontrolled, objectively active disease, and escalation of therapy to biological agents is typically ineffective in resolving their symptoms.  The cause of these IBS-like symptoms is unclear, but it has been suggested that changes in the gut-brain axis , epithelial barrier dysfunction, and the gut flora may be partially responsible. 
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