Draft:Management of irritable bowel syndrome

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Lifestyle

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According to NICE guidelines, those with IBS should receive information regarding the significance of self-help, such as lifestyle, physical activity, diet, and symptom management, in managing IBS. NICE guidelines recommend that healthcare professionals encourage those with IBS to make the most of their leisure time and take time to relax. NICE guidelines also recommend assessing the physical activity levels of those with IBS; healthcare professionals are advised to give advice and counselling to those with low activity levels.[1]

Lifestyle habits such as diet, sleep, exercise, and other behaviours can all play in role in IBS symptoms. Exercise such as yoga, aerobics, and walking can help manage the symptoms of IBS.[2][3]

Dietary

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At least 80% of those with IBS have food-related symptoms. Those who have food-related symptoms tend to experience more severe symptoms.[4] Many people with IBS are therefore willing to make dietary modifications.[5] There are many mechanisms in which food can trigger IBS symptoms such as osmotic, immunological, chemical, mechanical or neuroendocrine effects and fermentation by-products, alterations in intraluminal pH or effects on the gut microbiome.[6][5]

General advice for diet in those with IBS includes eating regular meals, taking time to eat, avoiding missing meals or large gaps between eating, reducing the consumption of fat, limiting the consumption of fizzy drinks and alcohol, avoiding spicy foods, restricting caffeinated beverages to 3 cups per day, and drinking at least 8 cups of fluid a day.[1][7]

Fibre

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Dietary fibre is a carbohydrate that is not digested through the small intestine and has a polymerization degree of three or more monomeric units. The US Food and Drug Administration recommends 25–35 grams of fiber per day.[8] NICE guidelines recommend that healthcare professionals review the intake of fibre for those with IBS and make adjustments while monitoring symptoms.[9][7] Insoluble fibre is often discouraged for those with IBS, as it can worsen symptoms, while soluble fibre is recommended.[10][11] Insoluble fibre is found in wheat bran, whole grains, and fruit and vegetable skins and seeds.[12] Soluble fibre is found in psyllium, oat bran, barley, and beans.[8]

FODMAP

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NICE guidelines recommend that if a person does not respond to general lifestyle and diet advice a low FODMAP diet (LDF) should be implemented with the help of a healthcare professional who has education in dietary management.[9]

Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are poorly absorbed short-chain carbohydrates that cause bacterial fermentation to release gases, primarily hydrogen and carbon dioxide, and increase the water content of the small intestine by osmosis.[13] A LFD is introduced in multiple stages. The first phase typically lasts 4-8 weeks and involves cutting out all FODMAP foods. The following phase, which lasts six to ten weeks, is introduced if people's symptoms improve. With the reintroduction of FODMAPs, individuals are able to identify the specific FODMAP triggers that cause their symptoms. Individuals then move on to the long-term personalization phase, during which they consume a less restrictive diet and just avoid FODMAPs that cause symptoms.[14][15]

Probiotics

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Probiotics can be helpful in treating symptoms of IBS however there is not enough evidence that specific strains are more effective than others.[16][17] The British Society of Gastroenterology and Canadian Association of Gastroenterology guidelines both recommend that people who choose to take probiotics should do so for a limited amount of time and stop them if they do not improve symptoms.[10][18] NICE guidelines recommend that people should take probiotics according to the manufacturer's recommended dosage.[9]

Pharmacological

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Psychological

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NICE guidelines recommend that people with IBS who don’t respond to IBS medication after a year and continue to develop symptoms, known as refractory IBS, should try psychological interventions such as cognitive behavioural therapy (CBT), hypnotherapy, or other psychological interventions.[19]

CBT and hypnotherapy have both been found to be effective in managing IBS.[20] CBT can be administered over the phone, face-to-face, or in a group setting.[21][22] These therapies incorporate a variety of skills-based methods, including exposure, behavioural experiments with avoiding symptoms or situations where they occur, cognitive reframing of negative ideas, relaxation training, and reducing helplessness. They can also involve methods that change how pain is perceived by stimulating brain regions that reduce gut sensations and boost psychological adaptability, acceptance, and self-efficacy.[23] Multicomponent psychological treatment and in-person dynamic psychotherapy can be helpful interventions. However, there is a lack of evidence on these kinds of psychological interventions.[22]

Complementary and alternative

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References

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Citations

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  1. ^ a b NICE 2008, p. 13.
  2. ^ Okawa 2022, pp. 3–4.
  3. ^ Chamera-Cyrek et al. 2024, p. 4.
  4. ^ Böhn et al. 2013, p. 637.
  5. ^ a b Vasant et al. 2021, p. 1226.
  6. ^ Moayyedi, Simrén & Bercik 2020, pp. 407–408.
  7. ^ a b Rej et al. 2022, p. 2.
  8. ^ a b Chey et al. 2022, p. 1740.
  9. ^ a b c NICE 2008, p. 14.
  10. ^ a b Vasant et al. 2021, p. 1227.
  11. ^ Moayyedi et al. 2019, p. 15.
  12. ^ Lacy et al. 2020, p. 29.
  13. ^ Hill, Muir & Gibson 2017, p. 37.
  14. ^ Whelan et al. 2018, pp. 245, 246, 249, 250.
  15. ^ Rej et al. 2022, p. 4.
  16. ^ Jia et al. 2020, p. 73.
  17. ^ Goodoory et al. 2023, p. 1214.
  18. ^ Moayyedi et al. 2019, p. 17.
  19. ^ NICE 2008, p. 16.
  20. ^ Moayyedi et al. 2019, p. 19.
  21. ^ Vasant et al. 2021, p. 1231.
  22. ^ a b Black et al. 2020, p. 1449.
  23. ^ Lacy et al. 2020, p. 37.

Sources

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