The role of diet in the management of irritable bowel syndrome: a focus on FODMAPs

Introduction: Irritable bowel syndrome is a common condition that negatively impacts quality of life and results in significant health care expenditures. The vast majority of IBS patients associate their symptoms with eating. Numerous randomized, controlled trials suggest that restriction of dietary FODMAPs improves overall symptoms, abdominal pain, bloating and quality of life in more than half of IBS sufferers. There is emerging data which suggests that other diets (gluten free, guided elimination diets) might also be of benefit to IBS patients.

Areas covered: Comprehensive literature review on dietary therapies available for IBS to date and exploration into individualized dietary therapy development based on diagnostic testing.

Expert commentary: FODMAP elimination identifies IBS patients who are sensitive to FODMAPs. Responders should undergo a structured reintroduction of foods containing FODMAPs to determine a patient’s sensitivities. This information can then be used to create a personalized, less restrictive low FODMAP diet. Future research should focus on the identification of other effective diet therapies focusing on supplementation of functional foods in addition to elimination and the development of biomarker-based diet treatment plans which identify the right treatment for the right patient.     

The role of psychosocial factors in irritable bowel syndrome.

Psychosocial factors, as appreciated within the context of the biopsychosocial model, are necessary for understanding the clinical expression of irritable bowel syndrome (IBS) by virtue of their key roles in the development, precipitation and perpetuation of IBS. Addressing psychosocial factors in assessment and management leads to improvement in the clinical outcome for IBS patients. Pertinent management components include adopting a 'care' approach within an ongoing collaborative treatment relationship; offering any psychological or psychiatric intervention as part of a multi-disciplinary treatment approach; providing education and reassurance; and using mental health professionals when indicated.     

Psychological factors in the irritable bowel syndrome.

This paper reviews recent psychological studies of patients with the irritable bowel syndrome (IBS) or 'functional abdominal pain'. Many studies have used unreliable or invalid methods of assessment and some have confused personality with treatable psychiatric illness. Reliable and valid measures have indicated that 40-50% of patients with recently diagnosed functional abdominal pain have demonstrable psychiatric illness; these patients have a worse prognosis than those who are psychologically normal. When psychiatric disorder is diagnosed in a patient with IBS there are three possibilities: (1) The patient may have developed abdominal and psychiatric symptoms simultaneously in which case treatment of the latter may relieve the bowel symptoms. (2) Psychiatric disorder may precipitate increased concern about bowel symptoms, and consequent attendance at the gastroenterology clinic, of those with chronic mild symptoms. In this case it is illness behaviour, rather than abdominal symptoms, that is caused by the anxiety/depression. (3) Those with chronic neurotic symptoms as part of their personality must be screened for organic disease if they have a fresh onset of bowel symptoms; but they are at high risk of becoming persistent clinic attenders. Further research is needed to clarify when psychological abnormalities play a role in the aetiology of IBS and when they are coincidental, but lead to illness behaviour. The role of psychological factors in the aetiology of the irritable bowel syndrome (IBS) is far from clear, but a review of the literature suggests that some consistent patterns are emerging in spite of methodological problems. There have been three major defects with studies that have linked IBS with neurotic symptomatology. First, the measurement of psychological factors has generally been imprecise. Second, most studies have considered IBS patients as a single group, without making allowance for differing symptom patterns. Third, conclusions have been drawn about hospital samples and extrapolated to all IBS subjects, without taking account of factors which affect consulting behaviour. Most studies have been concerned with psychological factors so these will be considered in most detail.     

Risk factors for irritable bowel syndrome: role of analgesics and food sensitivities

OBJECTIVE: Symptoms of irritable bowel syndrome (IBS) are reported by 10% of the general population; however, evaluation of traditional risk factors has not provided any insight into the pathogenesis of this condition. The objective of this study was to identify additional risk factors for irritable bowel syndrome. METHODS: A valid self-report questionnaire that records the gastrointestinal (GI) symptoms required for a diagnosis of IBS, self-reported measures of potential risk factors, and a psychosomatic symptom checklist was mailed to an age-and gender-stratified random sample of Olmsted County, Minnesota residents aged 30-64 yr. A logistic regression model that adjusted for age, gender, and psychosomatic symptom score was used to identify factors significantly associated with IBS. RESULTS: A total of 643 (72%) of 892 eligible subjects returned the survey. IBS symptoms were reported by 12% of the respondents. IBS was significantly associated with use of analgesics (acetaminophen, aspirin, or nonaspirin nonsteroidal antiinflammatory drugs) for reasons other than IBS, reporting a food allergy or sensitivity, and ratings of somatic symptoms. No association was detected for age, gender, body mass index, smoking history, alcohol use, educational level, exposure to pets in the household, or water supply. Among subjects reporting the use of just one type of analgesic, IBS was associated with acetaminophen but not aspirin or nonaspirin nonsteroidal antiinflammatory drugs used alone. The odds of having IBS were higher among subjects reporting more reasons for taking analgesics and intolerance to a higher number of foods. CONCLUSIONS: IBS is significantly associated with analgesic use. However, this is confounded by other somatic pain complaints. IBS symptoms are associated with the reporting of many food allergies or sensitivities. The role of food-induced symptoms in IBS requires further investigation.     

Risk factors for irritable bowel syndrome in Turkish population: role of food allergy

GOALS: The aim of this study was to determine the prevalence of food hypersensitivity in Turkish patients with irritable bowel syndrome (IBS). BACKGROUND: The IBS is a chronic disease of the gastrointestinal tract characterized by abdominal pain, distension, meteorism and either diarrhea or constipation. The role of diet in the pathogenesis of IBS remains controversial. Many investigators have shown that individual foods can trigger symptoms in some patients; nevertheless, the percentage of patients that benefit from dietary manipulation ranges from 15% to 67% in different reports. STUDY: Skin prick test to 11 common allergens, total IgE, eosinophilic cationic protein and eosinophil counts were evaluated in 100 patients satisfying the Rome II criteria and compared with 25 healthy controls. The history and physical examination of the groups were recorded and Beck Depression and Anxiety Inventories were performed. RESULTS: One hundred patients were entered into the study with a mean age of 45.63+/-12.91 years. Of the patients 53 had constipation predominant, 19 had diarrhea predominant, and 28 had alternating type IBS. Skin prick tests positivity were more common among the IBS patients in comparison with controls (25% and 1%, respectively, P<0.05). Mean IgE values were higher in patients than controls (70.83+/-66.05 and 15.20+/-14.01 IU/mL, respectively, P<0.000). Eosinophilic cationic protein values were also higher in IBS patients than controls (16.75+/-11.28 and 11.56+/-4.72, respectively, P<0.05) Evaluation of Beck Depression Inventory showed that tendency to depression in patients with IBS was 38% and 4% in controls (P<0.05). CONCLUSIONS: According to our results, in patients complaining of IBS it is of importance to search for a food component. Clinical improvements can be observed after the introduction of an adequate exclusion diet.     

Role of psychological factors in the irritable bowel syndrome

Our study was designed to test the hypothesis that psychoneurosis in irritable bowel syndrome (IBS) may be the secondary effects of the unsatisfactory nature of the medical transactions (diagnosis, explanation, prognosis, and therapy) in IBS rather than a primary cause of the syndrome. We carried out psychometric assessments on three groups of subjects: 10 healthy volunteers, 12 patients diagnosed as suffering from benign gastrointestinal disease, and 18 patients with IBS. We found a significantly raised incidence of psychoneurosis in IBS, but the components of this were predominantly anxiety and obsession; the incidence of depression in all 3 groups was similar. We argue that the data support our hypothesis that the psychoneurotic manifestations are secondary components of IBS; the data do not support the hypothesis that IBS is a manifestation of depression.     

Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome

In this multivariate analysis of the irritable bowel syndrome (IBS) we describe the symptomatic and psychologic features of the condition and their possible contributions to health care seeking. We studied 72 IBS patients, 82 persons with IBS who had not sought medical treatment, and 84 normal subjects. All subjects received complete medical evaluation, diary card assessment of abdominal pain and stool habit, and standard psychologic tests of pain, personality, mood, stressful life events, illness behavior, and social support. Pain and diarrhea were the most important symptoms associated with patient status. When controlling for these symptoms we found that (a) IBS patients have a higher proportion of abnormal personality patterns, greater illness behaviors, and lower positive stressful life event scores than IBS nonpatients (p less than 0.001) and normals (p less than 0.001); (b) IBS nonpatients, although psychologically intermediate between patients and normals, are not different from normals (p less than 0.21); and (c) IBS nonpatients have higher coping capabilities, experience illness as less disruptive to life, and tend to exhibit less psychologic denial than patients. These factors may contribute to "wellness behaviors" among people with chronic bowel symptoms. We conclude that the psychologic factors previously attributed to the IBS are associated with patient status rather than to the disorder per se. These factors may interact with physiologic disturbances in the bowel to determine how the illness is experienced and acted upon.     

Promising role of D-amino acids in irritable bowel syndrome

Irritable bowel syndrome (IBS) is an important health care concern. Alterations in the microbiota of the gut-brain axis may be linked to the pathophysiology of IBS. Some dietary intake could contribute to produce various metabolites including D-amino acids by the fermentation by the gut microbiota. D-amino acids are the enantiomeric counterparts of L-amino acids, in general, which could play key roles in cellular physiological processes against various oxidative stresses. Therefore, the presence of D-amino acids has been shown to be linked to the protection of several organs in the body. In particular, the gut microbiota could play significant roles in the stability of emotion via the action of D-amino acids. Here, we would like to shed light on the roles of D-amino acids, which could be used for the treatment of IBS.     

The role of diagnostic testing in irritable bowel syndrome

This article discusses the diagnostic criteria and processes applicable to irritable bowel syndrome (IBS). The authors describe the various diagnostic criteria with a focus on the Rome criteria for IBS and the judicious application of historical information such as alarm features and the yield of various diagnostic modalities such as blood, stool, breath, and endoscopic tests.     

The role of food intolerance in irritable bowel syndrome

Irritable bowel syndrome patients frequently believe that food intolerances are to blame for many of their symptoms, although not uncommonly this is caused by the nonspecific increase in gut motility that occurs with food ingestion. Nevertheless, dietary manipulation may result in substantial improvement in IBS symptomatology provided it is individualized to the particular patient. By further understanding the mechanisms involved in dietary intolerance, it should be possible to optimize the benefits of this approach to treatment.     

Gut microbiota role in irritable bowel syndrome: New therapeutic strategies

In the last decade the impressive expansion of our knowledge of the vast microbial community that resides in the human intestine, the gut microbiota, has provided support to the concept that a disturbed intestinal ecology might promote development and maintenance of symptoms in irritable bowel syndrome(IBS). As a correlate, manipulation of gut microbiota represents a new strategy for the treatment of this multifactorial disease. A number of attempts have been made to modulate the gut bacterial composition, following the idea that expansion of bacterial species considered as beneficial(Lactobacilli and Bifidobacteria) associated with the reduction of those considered harmful(Clostridium, Escherichia coli, Salmonella, Shigella and Pseudomonas) should attenuate IBS symptoms. In this conceptual framework, probiotics appear an attractive option in terms of both efficacy and safety, while prebiotics, synbiotics and antibiotics still need confirmation. Fecal transplant is an old treatment translated from the cure of intestinal infective pathologies that has recently gained a new life as therapeutic option for those patients with a disturbed gut ecosystem, but data on IBS are scanty and randomized, placebo-controlled studies are required.     

肠易激综合征患者心理评价

目的　比较肠易激综合征 (IBS)患者和健康人在个性、焦虑、抑郁、生活事件等方面的差别 ,以揭示个性、焦虑、抑郁、生活事件与IBS的关系。方法　采用龚氏修订的艾森克个性问卷 (成人版 )、宗氏抑郁自评量表、焦虑自评量表及生活事件量表对 89例IBS患者及 73例健康人进行评分。结果　IBS患者内外向分值显著低于健康人 (5 0 .47± 11.63∶5 8.40± 9.87,P <0 .0 0 1) ,而神经质、抑郁、焦虑、负性生活事件分值分别显著高于健康人 (分别为 5 6.85± 13 .2 6∶48.78± 13 .45 ;5 2 .75± 14 .70∶41.2 0± 7.68;5 3 .0 4±15 .5 9∶41.42± 8.90 ;5 2 .71± 5 9.81∶3 5 .2 2± 3 1.42 ,P <0 .0 5 )。结论　内倾和神经质个性、焦虑、抑郁及负性生活事件与肠易激综合征密切相关