AGA Clinical Practice Update on Role of Diet in Irritable Bowel Syndrome

In a new review, William D. Chey and their team have done an intensive study and provided a series of best practice advice for patients with Irritable Bowel Syndrome (IBS). This expert review was commissioned and approved by the AGA CPU Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership.

The review of AGA Clinical Practice Update on Role of Diet in Irritable Bowel Syndrome has been published in the Gastroenterology journal.

Irritable Bowel Syndrome is a frequent clinical illness that can have a significant influence on one's quality of life. The majority of IBS patients relate their gastrointestinal symptoms with eating. A growing body of research suggests that dietary changes, such as the low–fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) diet, can be used as a main therapy for IBS symptoms.

Best Practices

• Dietary guidance is best provided to IBS patients who are aware of their meal-related gastrointestinal symptoms and motivated to make the required adjustments. If a gastrointestinal registered dietitian nutritionist (RDN) is not accessible, alternative resources might help with diet intervention implementation.
• Patients with IBS who are not good candidates for restrictive diet therapies should be screened for disordered eating or eating disorders using a comprehensive dietary history. These problems are widespread and sometimes ignored in gastrointestinal ailments.
• Specific dietary treatments should be tried for a set period of time. If there is no clinical benefit, the diet therapy should be dropped in favor of another therapy option.
• Patients should give dietary information that will aid in the development of a customized nutrition care plan in advance of a meeting with an RDN.
• Soluble fiber is effective in relieving the overall symptoms of IBS.
• The low-FODMAP diet is by far the most evidence-based diet strategy for IBS right now.
• The low-FODMAP diet is divided into three phases: 1) restriction, 2) restoration of FODMAP foods, and 3) customization based on reintroduction outcomes.
• Although observational studies have revealed that most IBS patients benefit from a gluten-free diet, randomized controlled trials have produced inconsistent outcomes.
• Although there is minimal evidence that some biomarkers can predict responsiveness to diet therapy in IBS patients, there is insufficient evidence to justify their routine use in clinical practice.

In conclusion, specific dietary treatments should only be performed for a limited time; if no clinical response is obtained, the dietary intervention should be discontinued and/or shifted to a different treatment.

Reference

Chey, W. D., Hashash, J. G., Manning, L., & Chang, L. (2022). AGA Clinical Practice Update on the Role of Diet in Irritable Bowel Syndrome: Expert Review. In Gastroenterology (Vol. 162, Issue 6, pp. 1737-1745.e5). Elsevier BV. https://doi.org/10.1053/j.gastro.2021.12.248