ABSTRACT
Irritable bowel syndrome (IBS) is a common functional bowel disorder characterized by pain and bowel movement changes. Affecting up to 25% of the world’s population, it has dramatic impacts on health outcomes including morbidity, healthcare costs, and quality of life. Diagnosis is challenging. No definitive test exists for all forms of IBS and, despite calls for change, this condition is often still considered a diagnosis of exclusion, leading patients to receive extensive and invasive workups before a diagnosis is settled on. While most still consider IBS idiopathic, many potential causes and contributors have been elucidated including altered gastrointestinal motility, infection, visceral hypersensitivity, intestinal hyperpermeability, immune activation, altered microbiota, and bile acid malabsorption as well as others. Treatments for IBS are myriad, which likely speaks to the many causes and complex mechanisms of this condition. Pharmaceutical approaches are the mainstay of conventional management, but nonpharmaceutical approaches including cognitive behavior therapy, biofeedback, hypnosis, exercise, acupuncture, and yoga as well as others also have research support. Of considerable interest to patients and clinicians alike are dietary approaches. While traditionally the role of diet has been overlooked, patients with IBS consistently claim that diet plays a role in their symptoms, and more recent research supports this. Evidence is accumulating for the specific roles that alcohol, caffeine, dairy, fiber, gluten, FODMAPs, histamine, and spicy foods play in IBS. Additionally, targeted dietary interventions such as elemental diets and elimination diets, and even how we eat our food (food hygiene) are now being recognized as essential in the management of this complex syndrome.
