An Asian perspective on irritable bowel syndrome

Kee Wook Jung; Seung-Jae Myung

doi:10.5217/ir.2021.00136

Articles

Page Path: HOME > Intest Res > Volume 21(2); 2023 > Article

Review An Asian perspective on irritable bowel syndrome: Kee Wook Jung, Seung-Jae Myung^,; Intestinal Research 2023;21(2):189-195.
DOI: https://doi.org/10.5217/ir.2021.00136
Published online: May 31, 2022

Department of Gastroenterology, Asan Medical Center and Digestive Diseases Research Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to Seung-Jae Myung, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3917, Fax: +82-2-476-0824, E-mail: sjmyung@amc.seoul.kr

• Received: October 5, 2021 • Revised: December 16, 2021 • Accepted: January 16, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev next

5,089 Views
610 Download
6 Web of Science
6 Crossref
5 Scopus

Full Article

Download PDF

Abstract
INTRODUCTION
DIFFERENCE IN EPIDEMIOLOGY AND DIAGNOSIS OF IBS BETWEEN THE EASTERN AND THE WESTERN COUNTRIES
ROLE OF DIET IN THE PATHOGENESIS OF IBS IN ASIAN PATIENTS
ROLE OF DIET IN THE MICROBIAL CHANGE IN ASIAN PATIENTS WITH IBS
TREATMENT OF ASIAN PATIENTS WITH IBS
CONCLUSIONS
NOTES
REFERENCES

Abstract

Irritable bowel syndrome (IBS) is a prevalent chronic disorder, and its epidemiology depends on the diagnostic criteria used. Recently, the Rome IV criteria for IBS were published by changing the frequency of abdominal pain and excluding abdominal discomfort from the previously used Rome III criteria. However, the recent Asian consensus on IBS recommends the inclusion of abdominal discomfort and abdominal pain as diagnostic criteria. The low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP) diet has been proven to be effective in Western patients. Moreover, recent well-designed studies reported its effectiveness and the microbial changes after implementing it in Asian patients with IBS. However, traditional Korean foods including kimchi, one of representative FODMAP-rich food, exhibited a poor correlation with the food-related symptoms of IBS. Therefore, the low FODMAP diet protocol should be cautiously applied to IBS patients, especially to Korean patients with IBS. In Asian countries, there are lots of traditional herbal medicines and treatments for IBS; however, these studies have limitations including the heterogeneity of herbal mixtures and relatively small sample size. Therefore, well-designed studies based on large samples are required to validate complementary and alternative medicine in the treatment of Asian patients with IBS.
Keywords: Irritable bowel syndrome; Diagnosis; Therapy

INTRODUCTION

Irritable bowel syndrome (IBS) is a prevalent chronic disorder characterized by abdominal pain associated with altered bowel habits with changes in stool frequency and/or form. IBS is common in worldwide population-based study [1,2]. However, a recent study has reported the difference in the prevalence determined using the Rome III and IV criteria [1]. The complex pathogenesis of IBS includes visceral hypersensitivity, disordered gut-brain interaction, cytokine-mediated inflammation, dysmotility in gastrointestinal tract, and mucosal immune dysfunction [3-6]. Thus, IBS is caused by a combination of factors, including different pathophysiologic mechanisms [4]. During the evolution of studies regarding pathogenetic mechanism of IBS, the role of diet has been emphasized, and the concept of low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP) diet has been developed by Western countries [7,8]. However, the dietary habits in Western and Asian countries are quite different [9]. Moreover, Asian countries have a long history of using their own herbal medicines for the treatment of functional gastrointestinal disorders including IBS [10]. However, the efficacy of most of these medicines has not been validated. In this review, we aimed to investigate the current issues of IBS in Asian patients of IBS compared with Western point of view.

DIFFERENCE IN EPIDEMIOLOGY AND DIAGNOSIS OF IBS BETWEEN THE EASTERN AND THE WESTERN COUNTRIES

The prevalence of IBS varies by geographic regions and populations [1,2,10]. Moreover, the prevalence has changed due to the use of different diagnostic criteria, starting from Manning criteria to recently published Rome IV criteria [10]. A population-based survey in Korea reported a prevalence of 7.1% in men and 6.0% in women using the Rome II criteria [11]. However, another population-based survey in Korea revealed a prevalence of 7.0% in males and 11.0% in females using the Rome III criteria [12]. Finally, an internet survey in Korea reported a prevalence of 4.7% (3.8%–5.6%) using the Rome IV criteria [1]. Recently, a global epidemiologic study compared the prevalence of IBS determined using the Rome III and IV criteria [1]. The study found that the pooled prevalence rate of IBS determined using the Rome III was higher than that determined using the Rome IV criteria, regardless of sex [1,13]. The reason for this difference is the fact that the currently using Rome IV criteria is more stringent than the previously used Rome III criteria [14]. A major difference between the Rome III and IV criteria is the exclusion of abdominal discomfort from the Rome III criteria and the retention of only abdominal pain in the Rome IV criteria [14]. The reason is that some cultural backgrounds and languages do not have appropriate terminology for discomfort [13,15]. Moreover, the term “improvement with defecation” in the Rome III criteria was changed to “related” to defecation in the Rome IV criteria. Finally, the frequency of symptoms was changed from “at least 3 days per month” in the Rome III criteria to “at least 1 day per week” in the Rome IV criteria [14]. However, the recent Asian consensus on IBS accepted the terminology of recurrent abdominal discomfort as well as abdominal pain despite the low evidence [16]. The consensus group reported that pain is not a universal symptom in patients with IBS [16]. Moreover, consensus group described that the Asian patients with IBS might have only mild symptoms including abdominal discomfort or bloating [16]. A study from Singapore showed that 62% of patients with IBS complained of abdominal bloating rather than abdominal pain [17]. Another study from Hong Kong reported that 68% of patients with IBS complained of abdominal bloating [18]. However, only 32% of Hong Kong patients with IBS complained of abdominal pain.18 On the other hand, a study from the United States reported that 100% of patients with IBS complained of abdominal pain [19]. However, 83% of patients with IBS complained of abdominal bloating [19]. Additionally, the frequency of IBS symptoms varies across countries [15,20]. The reported rates of abdominal pain were the highest in Italy and the lowest in Calcutta, India [10,20,21]. Cultural backgrounds and dietary pattern including vegetarian dietary pattern may contribute to these differences [10,21]. Therefore, the diagnostic cutoff for symptom frequency and duration still needs to be validated in Asian patients with IBS [16].

ROLE OF DIET IN THE PATHOGENESIS OF IBS IN ASIAN PATIENTS

Diet is known to be an important factor in the pathogenesis of IBS [4,6-8,22]. However, the dietary habits in Western and Asian countries are quite different [9]. For example, the traditional Asian diets are composed of a higher amount of fiber than most Western diet [15]. Therefore, the approach for dietary habit adjustment and diet education in Asian patients with IBS could be different from that in Western patients [9]. FODMAPs, which are naturally found in various kinds of foods, are a group of easily fermentable short-chain carbohydrates that are either indigestible or absorbed slowly in the small intestine; the role of FODMAPs has been emphasized in the pathogenesis of IBS [9,22,23]. Moreover, they can easily undergo colonic fermentation [23]. Therefore, they may cause abdominal distension and release gases (hydrogen, carbon dioxide, and methane) due to intestinal bacterial fermentation [23].

1. Role of FODMAP in Asian Diet

Since the introduction of the concept of a low FODMAP diet for the treatment of IBS, studies in Western countries have shown that a low FODMAP diet is more effective compared with conventional Western diet including traditional Australian diet [24]. Moreover, few recent studies have shown that a low FODMAP diet is more effective in Asian patients with IBS compared with conventional Asian foods [25-27]. Usually, traditional Korean food includes white rice and various side dishes containing seasonings and sauces [9,28]. Rice has low fiber content, which is absorbed nearly completely in the small intestine. Rice is main source of carbohydrate in Asian people. On the other hand, kimchi is a traditional Korean side dish that contains FODMAP-rich ingredients, such as garlic, napa cabbage, and onion [28]. Moreover, kimchi is usually served as a side dish with nearly all Korean foods. Therefore, it is difficult to restrict kimchi consumption in Korean people. A recent questionnaires-based cross-sectional study from Korea investigated the difference between the IBS group (n=186) and non-IBS group (n=671) [29]. The study found that the IBS group had significantly higher FODMAP intake than the non-IBS group (13.9 ± 9.9 g/day vs. 12.6 ± 9.7 g/day, P=0.030) [29]. Moreover, the IBS group consumed a significantly higher amount of fat than the non-IBS group (86.6 ± 55.1 g/day vs. 76.9 ± 47.9 g/day, P=0.014) [29]. Additionally, foods containing high amount of fat and gluten such as instant noodles (70.8%), Chinese noodles with vegetables and seafood (68.7%), pizza (67.2%), and black bean sauce noodles (66.3%) were correlated with IBS symptoms [29]. Another Korean study based on self-reported questionnaire on food habits also suggested that fat-rich foods (25.0%), gluten-rich foods (23.8%), spicy foods (15.0%), and dairy products (15.0%) were associated with symptoms in patients with symptomatic IBS (n=167) compared with that in asymptomatic controls (n=125) [30]. The most common Korean food causing IBS symptoms were shown to be whole milk (34.7%), instant ramen (28.7%), black bean sauce noodles (24.8%), and pizza/hamburger (23.8%) [30]. Previous FODMAP diet trials reported a total FODMAP intake of approximately 17–30 g/day in Western countries [31-33]. A comparison between studies regarding the amount of FODMAP consumed by IBS patients in Korea and Western countries revealed a relatively lower consumption of FODMAP in Korean patients with IBS than that in Western patients with IBS. Interestingly, the results of the abovementioned studies indicate that traditional Korean foods including kimchi, which is a FODMAP-rich food, have a poor correlation with the food-related symptoms of IBS [29]. Therefore, one must be careful while applying the low FODMAP diet protocol developed by studies conducted in Western countries to Asian patients with IBS, especially to Korean patients with IBS [29]. The recent Asian consensus on IBS also emphasized the need of further studies to validate the role of a low FODMAP diet for the management of IBS [16].

2. Content of FODMAP in Asian Diets

Another issue is the lack of knowledge about the exact FODMAP content in Asian foods among Asian patients with IBS [26]. Unlike the exact FODMAP content in Western foods, the exact FODMAP content in Asian foods is difficult to measure [26]. Generally, complex recipes are used to prepare Asian foods, including bibimbap in Korea or pad thai in Thailand, using more than 5 ingredients and FODMAP-rich sauces [9,27]. Traditional Korean foods are served with more than 5 side dishes. Therefore, a mixture of more than 25 ingredients is consumed per Korean meal, making the exact calculation of FODMAP content in Asian foods very difficult [27,29]. It is possible to under-or overestimate the FODMAP content in Asian foods [26].

3. Effectiveness of a Low FODMAP Diet in Asian IBS

However, recently published well-designed controlled trials in Asian countries also showed the effectiveness of a low FODMAP diet in patients with IBS [25,26]. A prospective randomized trial in India including patients with diarrhea-predominant IBS who were categorized into the low FODMAP diet (n=52) and traditional dietary advice (n=49) groups reported symptomatic improvement in a significantly higher number of patients in the low FODMAP diet group than that in the traditional dietary advice group (32/51 [62.7%] vs. 20/49 [40.8%], P=0.0448) 4 weeks after the implementation of the diets [26]. This effect of diet continued up to 16 weeks (52.9% in the low FODMAP group vs. 30.6% in the traditional dietary advice group, P=0.0274) [26]. Another randomized controlled study in China including patients with diarrhea-predominant IBS who were categorized into the low FODMAP (n=54) and traditional dietary advice (n=54) groups also showed similar results (30/54 in the low FODMAP group vs. 26/54 in the traditional dietary advice group) [25]. However, the low FODMAP group showed improvement in stool frequency and excessive passing of wind earlier than the traditional dietary advice group [25]. Moreover, a recently published systematic review and network meta-analysis based on 13 randomized controlled trials (RCTs) (a total of 944 patients including 275 Asian patients from 3 studies in Asian countries) also showed that a low FODMAP diet was the most effective treatment for abdominal pain, bloating, and distension [34].

4. Celiac Disease and Gluten-Related Disorders in Asia

Recently published papers showed a relatively higher prevalence of celiac disease in some Asian countries, including India (1.23% in Northern India) and Iran [35,36]. However, it is still a very rare disease in other Asian countries, including South Korea and Taiwan [36]; on the other hand, the concept of non-celiac gluten hypersensitivity or wheat hypersensitivity has evolved, although the concept of non-celiac gluten hypersensitivity is still controversial [37]. Interestingly, a recent meta-analysis including 22 studies with 6,991 patients with IBS has shown that 3.3% (95% confidence interval [CI], 2.3%–4.5%) of them had celiac disease. In this study, they examined 10 Iranian (n=3,123), 1 Chinese (n=758), and 3 Indian (n=795) studies [38]. Gluten and fructan in the FODMAP diet are thought to correlate with IBS-like symptoms in these patients [36]; however, it still needs more evaluation and research to validate this relationship.

ROLE OF DIET IN THE MICROBIAL CHANGE IN ASIAN PATIENTS WITH IBS

Previous studies have shown that diet is one of the important factors that affect the microbial environment in humans [4,7,34]. Previous studies in Western patients with IBS showed a reduction in the concentration and proportion of luminal Bifidobacterium species after implementing a low FODMAP diet [31]. Bifidobacteria are important butyrate producers in the colon, and butyrate has an important role in colonic health [39]. Another study from Sweden showed that non-responders to a low FODMAP diet had a higher baseline dysbiosis index score compared with responders to a low FODMAP diet [40]. A recent study in patients with IBS described the long-term effectiveness of a low FODMAP diet as well as the microbial change after implementing a low FODMAP diet [41]. The study found that two-thirds of enrolled patients showed symptomatic improvement after the implementation of a low FODMAP diet for 12 months, and there were no significant differences in baseline bifidobacteria count [41]. However, the microbial change after implementing a low FODMAP diet in Asian patients with IBS has not been studied well until recently.

A recently published Chinese study in patients with diarrhea-predominant IBS reported similar findings regarding the microbial change after implementing a low FODMAP diet [25]. Patients consuming a low FODMAP diet showed a reduction in carbohydrate-fermenting bacteria including Bifidobacterium and Bacteroides species [25]. Moreover, they showed decreased saccharolytic fermentation [25]. High saccharolytic fermentation activity at baseline was related to a high symptom burden (P=0.01) and a favorable therapeutic response to the low FODMAP diet [25]. An Iranian study on 42 patients with IBS showed a significant increase in Bacteroidetes species after implementing a low FODMAP diet. Moreover, the ratio of Firmicutes to Bacteroidetes species decreased significantly (P=0.001) [42]. However, further studies are required to understand the role of a low FODMAP diet in the long-term change of microbial environment in Asian patients with IBS.

TREATMENT OF ASIAN PATIENTS WITH IBS

Based on the recently published Asian consensus of IBS, the conventional treatment recommendations in Asian and Western countries are not different [16]. Complementary and alternative medicines (CAM) have been used in functional gastrointestinal disorders including IBS [43]. CAM therapies could be attractive to Asian patients who have failed to alleviate their symptoms by using conventional therapies for IBS.

In Asian countries, there are lots of traditional herbal medicines and treatments available for IBS [16]. The recent Asian consensus guideline suggested that some CAM, such as peppermint oil and Kampo, could be effective treatments for IBS in Asian patients [16]. The recently published American college of gastroenterology guideline also recommended the use of peppermint to improve global IBS symptoms [4]. Peppermint is an herbal medication for IBS. Its clinical benefits in patients with IBS have been shown to correlate with blockade of calcium channels by L-menthol and smooth muscle relaxation [44]. A recently published meta-analysis investigating the efficacy of peppermint for treating IBS identified 12 RCTs including 835 patients; among them, there were 101 Asian patients with IBS. An analysis based on 7 RCTs for the effect of peppermint oil (n=253) and placebo (n=254) on overall symptomatic improvement in patients with IBS revealed a relative risk of 2.39 (95% CI, 1.93–2.97; P<0.00001) [44]. Peppermint oil has been tested at a treatment for IBS in many Southwest Asian countries, including Iran and Bangladesh, and its use is currently increasing in other Asian countries due to data from Western publications [45,46].

There is little evidence for the efficacy of the treatment using Kampo, a Japanese herbal medicine, in patients with IBS [47]. One of the Kampos, called Daikenchuto, is a traditional gastrointestinal prokinetic herbal medicine; it has been shown to reduce the symptoms of constipation in a limited number of studies [16]. Shugan Jianpi Zhixie therapy has been used to treat diarrhea-predominant IBS [48]. In a recently published meta-analysis based on 7 RCTs including 954 patients, Shugan Jianpi Zhixie therapy was shown to significantly improve global IBS symptoms compared with placebo (relative risk, 1.61; 95% CI, 1.24–2.10; P=0.0004) [48]. Tongxie Yaofang is another CAM that has been tested in patients with diarrhea-predominant IBS. A recently published, double-blind, placebo-controlled randomized trial involving 160 patients with diarrhea-predominant IBS reported a significant improvement of global symptoms (57.5% vs. 37.5%, P=0.017) [49]. Thus, this treatment looks to be promising in the management of diarrhea-predominant IBS. Traditional Korean medicine is currently used under the national health insurance system for the management of IBS. However, there is an inadequacy of research findings to support this usage. Therefore, future research based on large number of cases is needed.

However, the designs of these studies have some limitations, including the heterogeneity of herbal mixtures and relatively small sample sizes, making it difficult to derive a strong conclusion based on them [10]. Therefore, well-designed studies based on larger sample sizes are needed in the future to validate the use of CAM for the treatment of IBS in Asian patients [16].

Acupuncture originated from traditional Chinese medicine [50]. The tips of needle are inserted into specific areas of the human body, which is believed to improve functional gastrointestinal symptoms. However, acupuncture’s effectiveness is still controversial [50]. A recently published meta-analysis paper showed that it did not show statistical differences based on 12 shamcontrolled studies (relative risk, 1.11; 95% CI, 0.88–1.38) [50].

CONCLUSIONS

The current status of IBS in Asian patients is different from that in Western patients. The direct application of a low FODMAP diet in Asian patients with IBS should be considered carefully. In the future, well-designed studies are required to validate the application of CAM including traditional Asian herbs for the treatment of IBS.

NOTES

Funding Source

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (grant No. 2021R1A6A1 A03040260) and a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant No. HI21C0198).

Conflict of Interest

Myung SJ is an editorial board member of the journal but was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.

Data Availability Statement

Not applicable.

Author Contribution

Conceptualization: Jung KW, Myung SJ. Funding acquisition: Myung SJ. Supervision; validation: Myung SJ. Writing - original draft: Jung KW, Myung SJ. Writing - review & editing: Jung KW. Approval of final manuscript: all authors.

REFERENCES

1. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation Global Study. Gastroenterology 2021;160:99–114.Article PubMed
2. Sperber AD, Dumitrascu D, Fukudo S, et al. The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review. Gut 2017;66:1075–1082.Article PubMed
3. Bouchoucha M, Devroede G, Girault-Lidvan N, Hejnar M, Mary F, Benamouzig R. Psychological profiles of irritable bowel syndrome patients with different phenotypes. Intest Res 2020;18:459–468.Article PubMed PMC PDF
4. Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol 2021;116:17–44.Article PubMed
5. Mitselou A, Grammeniatis V, Varouktsi A, Papadatos SS, Katsanos K, Galani V. Proinflammatory cytokines in irritable bowel syndrome: a comparison with inflammatory bowel disease. Intest Res 2020;18:115–120.Article PubMed PMC PDF
6. Shafiee NH, Razalli NH, Mokhtar NM, Tan E, Ali R. An evaluation of dietary adequacy among patients with constipation-predominant irritable bowel syndrome in Malaysia. Intest Res 2022;20:124–133.Article PubMed PMC PDF
7. Gibson PR, Halmos EP, Muir JG. Review article: FODMAPS, prebiotics and gut health-the FODMAP hypothesis revisited. Aliment Pharmacol Ther 2020;52:233–246.Article PubMed PDF
8. Liu J, Chey WD, Haller E, Eswaran S. Low-FODMAP diet for irritable bowel syndrome: what we know and what we have yet to learn. Annu Rev Med 2020;71:303–314.Article PubMed
9. Iacovou M, Tan V, Muir JG, Gibson PR. The low FODMAP diet and its application in East and Southeast Asia. J Neurogastroenterol Motil 2015;21:459–470.Article PubMed PMC
10. Gwee KA, Ghoshal UC, Chen M. Irritable bowel syndrome in Asia: pathogenesis, natural history, epidemiology, and management. J Gastroenterol Hepatol 2018;33:99–110.Article PubMed PDF
11. Han SH, Lee OY, Bae SC, et al. Prevalence of irritable bowel syndrome in Korea: population-based survey using the Rome II criteria. J Gastroenterol Hepatol 2006;21:1687–1692.Article PubMed
12. Park DW, Lee OY, Shim SG, et al. The differences in prevalence and sociodemographic characteristics of irritable bowel syndrome according to Rome II and Rome III. J Neurogastroenterol Motil 2010;16:186–193.Article PubMed PMC
13. Sperber AD. Epidemiology and burden of irritable bowel syndrome: an international perspective. Gastroenterol Clin North Am 2021;50:489–503.PubMed
14. Mearin F, Lacy BE, Chang L, et al. Bowel disorders. Gastroenterology 2016;150:1393–1407.Article
15. Chuah KH, Mahadeva S. Cultural factors influencing functional gastrointestinal disorders in the East. J Neurogastroenterol Motil 2018;24:536–543.Article PubMed PMC
16. Gwee KA, Gonlachanvit S, Ghoshal UC, et al. Second Asian consensus on irritable bowel syndrome. J Neurogastroenterol Motil 2019;25:343–362.Article PubMed PMC
17. Gwee KA, Wee S, Wong ML, Png DJ. The prevalence, symptom characteristics, and impact of irritable bowel syndrome in an Asian urban community. Am J Gastroenterol 2004;99:924–931.Article PubMed
18. Kwan AC, Hu WH, Chan YK, Yeung YW, Lai TS, Yuen H. Prevalence of irritable bowel syndrome in Hong Kong. J Gastroenterol Hepatol 2002;17:1180–1186.Article PubMed
19. Ringel Y, Williams RE, Kalilani L, Cook SF. Prevalence, characteristics, and impact of bloating symptoms in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2009;7:68–72.Article PubMed
20. Gerson CD, Gerson MJ, Awad RA, et al. Irritable bowel syndrome: an international study of symptoms in eight countries. Eur J Gastroenterol Hepatol 2008;20:659–667.Article PubMed
21. Ghoshal UC, Singh R. Frequency and risk factors of functional gastro-intestinal disorders in a rural Indian population. J Gastroenterol Hepatol 2017;32:378–387.Article PubMed PDF
22. Kim SE. Importance of nutritional therapy in the management of intestinal diseases: beyond energy and nutrient supply. Intest Res 2019;17:443–454.Article PubMed PMC PDF
23. Gibson PR. History of the low FODMAP diet. J Gastroenterol Hepatol 2017;32 Suppl 1:5–7.Article PubMed PDF
24. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014;146:67–75.Article PubMed
25. Zhang Y, Feng L, Wang X, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet compared with traditional dietary advice for diarrhea-predominant irritable bowel syndrome: a parallel-group, randomized controlled trial with analysis of clinical and microbiological factors associated with patient outcomes. Am J Clin Nutr 2021;113:1531–1545.Article PubMed PDF
26. Goyal O, Batta S, Nohria S, et al. Low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet in patients with diarrhea-predominant irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol Hepatol 2021;36:2107–2115.Article PubMed PDF
27. Patcharatrakul T, Juntrapirat A, Lakananurak N, Gonlachanvit S. Effect of structural individual low-FODMAP dietary advice vs. brief advice on a commonly recommended diet on IBS symptoms and intestinal gas production. Nutrients 2019;11:2856.Article PubMed PMC
28. Zhang Y, Ma ZF, Zhang H, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polypols diet and irritable bowel syndrome in Asia. JGH Open 2018;3:173–178.Article PubMed PMC PDF
29. Na W, Lee Y, Kim H, Kim YS, Sohn C. High-fat foods and FODMAPs containing gluten foods primarily contribute to symptoms of irritable bowel syndrome in Korean adults. Nutrients 2021;13:1308.Article PubMed PMC
30. Lee HJ, Kim HJ, Kang EH, et al. Self-reported food intolerance in Korean patients with irritable bowel syndrome. J Neurogastroenterol Motil 2019;25:222–232.Article PubMed PMC
31. Staudacher HM, Lomer MC, Anderson JL, et al. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr 2012;142:1510–1518.Article PubMed
32. Staudacher HM, Lomer M, Farquharson FM, et al. A diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and a probiotic restores Bifidobacterium species: a randomized controlled trial. Gastroenterology 2017;153:936–947.Article PubMed
33. Staudacher HM, Ralph F, Irving PM, Whelan K, Lomer M. Nutrient intake, diet quality, and diet diversity in irritable bowel syndrome and the impact of the low FODMAP diet. J Acad Nutr Diet 2020;120:535–547.Article PubMed
34. Black CJ, Staudacher HM, Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2022;71:1117–1126.Article PubMed
35. Ramakrishna BS, Makharia GK, Chetri K, et al. Prevalence of adult celiac disease in India: regional variations and associations. Am J Gastroenterol 2016;111:115–123.Article PubMed PDF
36. Mohta S, Rajput MS, Ahuja V, Makharia GK. Emergence of celiac disease and gluten-related disorders in Asia. J Neurogastroenterol Motil 2021;27:337–346.Article PubMed PMC
37. Potter M, Walker MM, Keely S, Talley NJ. What’s in a name? ‘Non-coeliac gluten or wheat sensitivity’: controversies and mechanisms related to wheat and gluten causing gastrointestinal symptoms or disease. Gut 2018;67:2073–2077.Article PubMed
38. Irvine AJ, Chey WD, Ford AC. Screening for celiac disease in irritable bowel syndrome: an updated systematic review and meta-analysis. Am J Gastroenterol 2017;112:65–76.Article PubMed PDF
39. Rej A, Aziz I, Tornblom H, Sanders DS, Simrén M. The role of diet in irritable bowel syndrome: implications for dietary advice. J Intern Med 2019;286:490–502.Article PubMed PDF
40. Bennet S, Böhn L, Störsrud S, et al. Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. Gut 2018;67:872–881.Article PubMed
41. Staudacher HM, Rossi M, Kaminski T, et al. Long-term personalized low FODMAP diet improves symptoms and maintains luminal Bifidobacteria abundance in irritable bowel syndrome. Neurogastroenterol Motil 2022;34:e14241.Article PubMed PDF
42. Naseri K, Dabiri H, Rostami-Nejad M, et al. Influence of low FODMAP-gluten free diet on gut microbiota alterations and symptom severity in Iranian patients with irritable bowel syndrome. BMC Gastroenterol 2021;21:292.Article PubMed PMC PDF
43. Deutsch JK, Levitt J, Hass DJ. Complementary and alternative medicine for functional gastrointestinal disorders. Am J Gastroenterol 2020;115:350–364.Article PubMed
44. Alammar N, Wang L, Saberi B, et al. The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. BMC Complement Altern Med 2019;19:21.Article PubMed PMC PDF
45. Merat S, Khalili S, Mostajabi P, Ghorbani A, Ansari R, Malekzadeh R. The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Dig Dis Sci 2010;55:1385–1390.Article PubMed PDF
46. Alam MS, Roy PK, Miah AR, et al. Efficacy of Peppermint oil in diarrhea predominant IBS-a double blind randomized placebo-controlled study. Mymensingh Med J 2013;22:27–30.PubMed
47. Fukudo S, Kaneko H, Akiho H, et al. Evaluation of Kampo medicine in the clinical practice guideline for irritable bowel syndrome. J Gastroenterol 2015;50:817–818.Article PubMed PDF
48. Xiao Y, Liu Y, Huang S, et al. The efficacy of Shugan Jianpi Zhixie therapy for diarrhea-predominant irritable bowel syndrome: a meta-analysis of randomized, double-blind, placebo-controlled trials. PLoS One 2015;10:e0122397.Article PubMed PMC
49. Chen M, Tang TC, Wang Y, et al. Randomised clinical trial: Tong-Xie-Yao-Fang granules versus placebo for patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2018;48:160–168.Article PubMed PDF
50. Wang XY, Wang H, Guan YY, Cai RL, Shen GM. Acupuncture for functional gastrointestinal disorders: a systematic review and meta-analysis. J Gastroenterol Hepatol 2021;36:3015–3026.Article PubMed PMC PDF

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

The Role of Diet in the Management of Irritable Bowel Syndrome: A Comprehensive Review
Maleesha Jayasinghe , Vinuri Karunanayake, Ali Mohtashim, Dilushini Caldera , Piyalka Mendis , Omesh Prathiraja, Fatemeh Rashidi, John A Damianos
Cureus.2024;[Epub] CrossRef
Downregulated APOD and FCGR2A correlates with immune infiltration and lipid-induced symptoms of irritable bowel syndrome
Yamei Ran, Kangqi Wu, Chenglin Hu, Renzheng Liang, Li Zhang, Juan Xiao, Yongmei Peng, Wenjing Sun
Scientific Reports.2023;[Epub] CrossRef
Technical Feasibility of Quantitative Measurement of Various Degrees of Small Bowel Motility Using Cine Magnetic Resonance Imaging
Ji Young Choi, Jihye Yun, Subin Heo, Dong Wook Kim, Sang Hyun Choi, Jiyoung Yoon, Kyuwon Kim, Kee Wook Jung, Seung-Jae Myung
Korean Journal of Radiology.2023; 24(11): 1093. CrossRef
Letter to the Editor: Survey-Based Analysis of Clinical Treatment Status of Irritable Bowel Syndrome in Korea: Suggestions for Future Research
Ji Young Chang
Journal of Korean Medical Science.2023;[Epub] CrossRef
Effectiveness of Medilac-S as an Adjuvant to Conventional Irritable Bowel Syndrome Treatments: A Systematic Review with Meta-Analysis
Annie Tremblay, Xiaoyu Xu, James Colee, Thomas A. Tompkins, Sylvie Binda
Gastroenterology Insights.2023; 14(4): 491. CrossRef
Comments on Efficacy of a Synbiotic Containing Lactobacillus paracasei DKGF1 and Opuntia humifusa in Elderly Patients with Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial
Kwang Woo Kim
Gut and Liver.2023; 17(6): 954. CrossRef

PubReader
ePub Link

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format: