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A low FODMAP diet effectively manages irritable bowel syndrome (IBS) symptoms in most patients. For non-responsive individuals, tailored therapies address visceral hypersensitivity, altered motility, or microbiome changes for optimal IBS management.

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Area of Science:

  • Gastroenterology
  • Dietetics
  • Microbiome Research

Background:

  • Irritable bowel syndrome (IBS) is a complex gastrointestinal disorder with heterogeneous patient presentations.
  • Effective management requires understanding IBS pathophysiology and implementing tailored therapeutic strategies.
  • A low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet is a primary intervention for IBS symptom relief.

Purpose of the Study:

  • To outline appropriate assessment and therapeutic approaches for patients with irritable bowel syndrome (IBS).
  • To detail management strategies for IBS patients unresponsive to initial dietary interventions.
  • To emphasize the role of dietitians in optimizing IBS treatment and preventing nutritional compromise.

Main Methods:

  • Review of current evidence for dietary and non-dietary interventions in IBS management.
  • Categorization of IBS treatment based on underlying pathophysiological mechanisms: visceral hypersensitivity, altered motility, and microbiome changes.
  • Guidance on selecting appropriate therapies, including low FODMAP diet, antispasmodics, probiotics, prebiotics, and lifestyle modifications.

Main Results:

  • A low FODMAP diet effectively reduces IBS symptoms in approximately 75% of patients.
  • Treatment for non-responsive IBS patients is stratified based on pathophysiology, including visceral hypersensitivity (low FODMAP, peppermint oil), altered motility (fiber, osmotic agents, stimulants), and microbiome alterations (probiotics, prebiotics).
  • Dietary interventions require careful guidance to ensure nutritional adequacy and psychological well-being.

Conclusions:

  • Personalized treatment strategies are crucial for managing heterogeneous IBS presentations.
  • Dietary interventions, particularly the low FODMAP diet, are highly effective but require tailored approaches for non-responders.
  • Dietitians play a vital role in guiding IBS patients toward effective, safe, and comprehensive management plans.