In addition, other challenges remain in designing dietary trials, including difficulties in manipulating the diet and the adherence and modification of dietary habits. The epidemiology of irritable bowel syndrome. To see the full article, log in or purchase access. As can be seen, macro- and micronutrient deficiencies can occur with any diet, and this highlights the importance of dietetic involvement in the implementation of dietary therapies and is supported by other reviews [ 40, 41 ]. Whilst GFDs are known as the mainstay of treatment for people with an established diagnosis of coeliac disease [ 13 ], we will explore the emerging evidence for this dietary therapy in individuals with IBS. Postgrad Med. Kinsey L. FODMAPs are short-chain carbohydrates which are rapidly fermentable and poorly absorbed, increasing the small bowel water content, passing unaltered into the colon, where they are rapidly fermented, generating gas and distention [ 70 ]. Journal List Nutrients v.
Functional disorders are common, with irritable bowel syndrome IBS being the commonest and most extensively evaluated functional bowel disorder. It is therefore paramount that effective therapies are available to treat this common condition. Diet appears to play a pivotal role in symptom generation in IBS, with a recent interest in the role of dietary therapies in IBS. However, there are questions with regards to which components of wheat lead to symptom generation, as well as the effect of a GFD on nutritional status, gut microbiota and long-term outcomes. Further studies are required, although the design of dietary studies remain challenging. The implementation of a GFD should be performed by a dietitian with a specialist interest in IBS, which could be achieved via the delivery of group sessions. Functional disorders are common, with the Rome IV guidelines classifying these disorders into oesophageal, gastroduodenal, bowel, centrally mediated, anorectal, gallbladder, and sphincter of Oddi disorders [ 1 ]. The commonest and most extensively evaluated functional bowel disorder is irritable bowel syndrome IBS, with a reported global pooled prevalence of 11 percent [ 2 ]. The pathophysiology of IBS is not fully understood, but several pathophysiological mechanisms have been proposed, including visceral hypersensitivity, inflammation, increased intestinal mucosal permeability, and genetic and psychological factors [ 3, 4 ]. The impact of IBS can lead to a significant impact on sufferers, with a reduced quality of life, increased time off work and greater utilisation of healthcare [ 5 ].
Therefore, a newly emerging condition termed non-celiac gluten sensitivity NCGS or non-celiac wheat sensitivity NCWS is now well established in the clinical practice. The mechanisms by which gluten or other wheat proteins trigger symptoms are poorly understood and the lack of specific biomarkers hampers diagnosis of this condition. The latter concept has been challenged by growing evidence showing low-grade inflammatory changes in the gut and altered gut-brain axis signaling. Indeed, FBDs are responsible for prolonged absenteeism from work as well as for suboptimal performance in the workplace with relevant social costs. In this context, recognized mechanisms in IBS span a wide spectrum including gut dysmotility, low-grade inflammation, visceral hypersensitivity, changes of gut microbiome, infections, altered gut barrier function, and genetic and psychosocial factors. The role of dietary factors in IBS pathogenesis is a topic of great interest. The majority of these patients report worsening of symptoms between 15 minutes to a few hours after meal intake. The aim of the present review is to provide an overview highlighting the major aspects of the complex interplay existing between foods and gut function with relevance to IBS.