Dietary treatment of irritable bowel syndrome

Food is a recognized trigger for most patients with irritable bowel syndrome (IBS). In recent years, an emerging evidence base has identified dietary manipulation as an important therapeutic approach in IBS.

Original and review articles were identified through selective searches performed on PubMed and Google Scholar.

Randomized controlled trials have supported the use of a diet that restricts a group of short-chain carbohydrates known collectively as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). There is evidence that specific probiotics may improve symptoms in IBS.

The role of a high-fibre diet remains subject to ongoing debate with a lack of high-quality evidence. The long-term durability and safety of a low FODMAP diet are unclear.

A paradigm shift has led to a focus on the relationship between diet and pathophysiological mechanisms in IBS such as effects on intestinal microbiota, inflammation, motility, permeability and visceral hypersensitivity.

Future large, randomized controlled trials with rigorous end points are required. In addition, predictors of response need to be identified to offer personalized therapy.