Diet and irritable bowel syndrome: an update from a UK consensus meeting

Rej, A.; Avery, A.; Aziz, I.; Black, C. J.; Bowyer, R. K.; Buckle, R. L.; Seamark, L.; Shaw, C. C.; Thompson, J.; Trott, N.; Williams, M.; Sanders, D. S.

Abstract

There has been a renewed interest in the role of dietary therapies to manage irritable bowel syndrome (IBS), with diet high on the agenda for patients. Currently, interest has focussed on the use of traditional dietary advice (TDA), a gluten-free diet (GFD) and the low FODMAP diet (LFD). A consensus meeting was held to assess the role of these dietary therapies in IBS, in Sheffield, United Kingdom.

Evidence for TDA is from case control studies and clinical experience. Randomised controlled trials (RCT) have demonstrated the benefit of soluble fibre in IBS. No studies have assessed TDA in comparison to a habitual or sham diet. There have been a number of RCTs demonstrating the efficacy of a GFD at short-term follow-up, with a lack of long-term outcomes. Whilst gluten may lead to symptom generation in IBS, other components of wheat may also play an important role, with recent interest in the role of fructans, wheat germ agglutinins, as well as alpha amylase trypsin inhibitors. There is good evidence for the use of a LFD at short-term follow-up, with emerging evidence demonstrating its efficacy at long-term follow-up. There is overlap between the LFD and GFD with IBS patients self-initiating gluten or wheat reduction as part of their LFD. Currently, there is a lack of evidence to suggest superiority of one diet over another, although TDA is more acceptable to patients.

In view of this evidence, our consensus group recommends that dietary therapies for IBS should be offered by dietitians who first assess dietary triggers and then tailor the intervention according to patient choice. Given the lack of dietetic services, novel approaches such as employing group clinics and online webinars may maximise capacity and accessibility for patients. Further research is also required to assess the comparative efficacy of dietary therapies to other management strategies available to manage IBS.

Citation

Rej, A., Avery, A., Aziz, I., Black, C. J., Bowyer, R. K., Buckle, R. L., …Sanders, D. S. (2022). Diet and irritable bowel syndrome: an update from a UK consensus meeting. BMC Medicine, 20(1), Article 287. https://doi.org/10.1186/s12916-022-02496-w

• Journal Article Type: Review
• Acceptance Date: Jul 25, 2022
• Online Publication Date: Sep 13, 2022
• Publication Date: Sep 13, 2022
• Deposit Date: Sep 16, 2022
• Publicly Available Date: Sep 16, 2022
• Journal: BMC medicine
• Electronic ISSN: 1741-7015
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 20
• Issue: 1
• Article Number: 287
• DOI: https://doi.org/10.1186/s12916-022-02496-w
• Keywords: Review, Irritable bowel syndrome, Low FODMAP diet, Gluten-free diet, Traditional dietary advice
• Public URL: https://nottingham-repository.worktribe.com/output/11199775
• Publisher URL: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-022-02496-w