Food: the forgotten factor in the irritable bowel syndrome.

After years of inattention, there is a growing body of evidence to suggest that dietary constituents at least exacerbate symptoms and perhaps contribute to the pathogenesis of the irritable bowel syndrome (IBS). Although patients with IBS self-report food allergies more often than the general population, the evidence suggests that true food allergies are relatively uncommon. Less clearly defined food intolerances may be an important contributor to symptoms in IBS patients. This article reviews the literature supporting a causal link between food and the symptoms of IBS as well as the evidence supporting dietary interventions as a means of managing IBS symptoms.

[1]  H. Ehrlein,et al.  Effects of enteral infusion of hypertonic saline and nutrients on canine jejunal motor patterns , 1993, Digestive Diseases and Sciences.

[2]  B. Zimmerman,et al.  Fructose Intolerance in IBS and Utility of Fructose-Restricted Diet , 2008, Journal of clinical gastroenterology.

[3]  H. Raybould Gut chemosensing: Interactions between gut endocrine cells and visceral afferents , 2010, Autonomic Neuroscience.

[4]  J. Borovička,et al.  Feedback regulation and sensation , 1994, Digestive Diseases and Sciences.

[5]  R. Gearry,et al.  Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease-a pilot study. , 2009, Journal of Crohn's & colitis.

[6]  J. Sanderson,et al.  Review article: lactose intolerance in clinical practice – myths and realities , 2007, Alimentary pharmacology & therapeutics.

[7]  D. Jewell,et al.  Food intolerance and the irritable bowel syndrome. , 1989, Gut.

[8]  W. Chey,et al.  Hyperglycemia inhibits mechanoreceptor-mediated gastrocolonic responses and colonic peristaltic reflexes in healthy humans. , 1995, Gastroenterology.

[9]  J. Murray,et al.  Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. , 2003, Archives of internal medicine.

[10]  A. Berstad,et al.  Patients with Subjective Food Hypersensitivity: The Value of Analyzing Intestinal Permeability and Inflammation Markers in Gut Lavage Fluid , 2004, Digestion.

[11]  Bock Sa Prospective Appraisal of Complaints of Adverse Reactions to Foods in Children During the First 3 Years of Life , 1987 .

[12]  M. Pimentel,et al.  Lactose Intolerance and the Role of the Lactose Breath Test , 2010, The American Journal of Gastroenterology.

[13]  P. Brandtzaeg Food allergy: separating the science from the mythology , 2010, Nature Reviews Gastroenterology &Hepatology.

[14]  G. Gasbarrini,et al.  EFFICACY OF ORAL DISODIUM CROMOGLYCATE IN PATIENTS WITH IRRITABLE BOWEL SYNDROME AND POSITIVE SKIN PRICK TESTS TO FOODS , 1986, The Lancet.

[15]  A. Zinsmeister,et al.  Comparison of breath testing with fructose and high fructose corn syrups in health and IBS , 2008, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[16]  F. Fernández-Bañares,et al.  Sugar malabsorption in functional abdominal bloating: a pilot study on the long-term effect of dietary treatment. , 2006, Clinical nutrition.

[17]  P. de Coppet,et al.  Short-chain fatty acids regulate the enteric neurons and control gastrointestinal motility in rats. , 2010, Gastroenterology.

[18]  G. Corazza,et al.  Coeliac disease , 2005, Journal of Clinical Pathology.

[19]  M. Zeitz,et al.  Predictors of clinical response to gluten-free diet in patients diagnosed with diarrhea-predominant irritable bowel syndrome. , 2007, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[20]  N. Read,et al.  Increased rectal mucosal expression of interleukin 1β in recently acquired post-infectious irritable bowel syndrome , 2003, Gut.

[21]  G. Di Fede,et al.  A cytologic assay for diagnosis of food hypersensitivity in patients with irritable bowel syndrome. , 2010, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[22]  R. Spiller,et al.  Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acuteCampylobacter enteritis and in post-dysenteric irritable bowel syndrome , 2000, Gut.

[23]  W. Chey,et al.  An Evidence-Based Position Statement on the Management of Irritable Bowel Syndrome , 2008, The American Journal of Gastroenterology.

[24]  R. Spiller,et al.  Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: postal survey of patients , 1997, BMJ.

[25]  D. Fuchs,et al.  Fructose- and sorbitol-reduced diet improves mood and gastrointestinal disturbances in fructose malabsorbers. , 2000, Scandinavian journal of gastroenterology.

[26]  R. Rona,et al.  A population study of food intolerance , 1994, The Lancet.

[27]  M. Benson,et al.  Food hypersensitivity and irritable bowel syndrome , 2001, Alimentary pharmacology & therapeutics.

[28]  D. Drossman,et al.  What Patients Know About Irritable Bowel Syndrome (IBS) and What They Would Like to Know. National Survey on Patient Educational Needs in IBS and Development and Validation of the Patient Educational Needs Questionnaire (PEQ) , 2007, The American Journal of Gastroenterology.

[29]  D. Drossman,et al.  A very low-carbohydrate diet improves symptoms and quality of life in diarrhea-predominant irritable bowel syndrome. , 2009, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[30]  F. Casellas,et al.  Subjective perception of lactose intolerance does not always indicate lactose malabsorption. , 2010, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[31]  A. Ananthakrishnan,et al.  Length of Office Visits for Gastrointestinal Disease: Impact of Physician Specialty , 2010, The American Journal of Gastroenterology.

[32]  J. Schulzke,et al.  Celiac disease-like abnormalities in a subgroup of patients with irritable bowel syndrome. , 2001, Gastroenterology.

[33]  T. Maudelonde,et al.  The Lancet: saturday 11 November 1989 , 1989 .

[34]  W. Chey,et al.  Utility of the Rome I and Rome II criteria for irritable bowel syndrome in U.S. women. , 2002 .

[35]  A. Cianferoni,et al.  Food allergy: review, classification and diagnosis. , 2009, Allergology international : official journal of the Japanese Society of Allergology.

[36]  C. Bindslev‐Jensen,et al.  Adverse reactions to food * , 1995 .

[37]  R. Gearry,et al.  Dietary poorly absorbed, short‐chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon , 2010, Alimentary pharmacology & therapeutics.

[38]  Tsung-Teh Wu,et al.  Lymphocytic Duodenosis and the Spectrum of Celiac Disease , 2009, The American Journal of Gastroenterology.

[39]  N. Talley,et al.  Are adverse food reactions linked to irritable bowel syndrome? , 1998, American Journal of Gastroenterology.

[40]  T. Sheldon,et al.  Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial , 2004, Gut.

[41]  Ulf Bengtsson,et al.  Food-Related Gastrointestinal Symptoms in the Irritable Bowel Syndrome , 2001, Digestion.

[42]  J. Tack,et al.  Altered intestinal microbiota in irritable bowel syndrome , 2010, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[43]  N. Powell,et al.  Increased prevalence of gastrointestinal symptoms in patients with allergic disease , 2007, Postgraduate Medical Journal.

[44]  A. Keshavarzian,et al.  Atopic irritable bowel syndrome: a novel subgroup of irritable bowel syndrome with allergic manifestations. , 2008, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[45]  N. Read Feedback regulation and sensation , 1994, Digestive Diseases and Sciences.

[46]  W. Heizer,et al.  The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. , 2009, Journal of the American Dietetic Association.

[47]  I. Gerogianni,et al.  Increased prevalence of irritable bowel syndrome in patients with bronchial asthma. , 2003, Respiratory medicine.

[48]  J. D. Di Palma,et al.  Clinical Impact of Identifying Lactose Maldigestion or Fructose Malabsorption in Irritable Bowel Syndrome or Other Conditions , 2009, Southern medical journal.

[49]  J. Tack,et al.  TRP channels in neurogastroenterology: opportunities for therapeutic intervention , 2011, British journal of pharmacology.

[50]  P. Gibson,et al.  Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. , 2008, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[51]  P. Gibson,et al.  Review article: fructose malabsorption and the bigger picture , 2006, Alimentary pharmacology & therapeutics.

[52]  J. Rumessen,et al.  Functional bowel disease: malabsorption and abdominal distress after ingestion of fructose, sorbitol, and fructose-sorbitol mixtures. , 1988, Gastroenterology.

[53]  J. Murray,et al.  Between Celiac Disease and Irritable Bowel Syndrome: The “No Man's Land” of Gluten Sensitivity , 2009, The American Journal of Gastroenterology.

[54]  P. Brandtzaeg Food allergy: separating the science from the mythology , 2010, Nature Reviews Gastroenterology &Hepatology.

[55]  H. Stankiewicz,et al.  Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints. , 2000, The Israel Medical Association journal : IMAJ.

[56]  G. Gasbarrini,et al.  Oral disodium cromoglycate treatment on irritable bowel syndrome: an open study on 101 subjects with diarrheic type. , 1992, The American journal of gastroenterology.

[57]  W. Chey,et al.  Yield of Diagnostic Testing in Patients with Suspected Irritable Bowel Syndrome (IBS): a Prospective, U.S. Multi-Center Trial , 2008 .

[58]  R. Spiller,et al.  Abnormal Intestinal Permeability in Subgroups of Diarrhea-Predominant Irritable Bowel Syndromes , 2006, The American Journal of Gastroenterology.

[59]  H. Sampson,et al.  AGA technical review on the evaluation of food allergy in gastrointestinal disorders , 2001 .

[60]  R. Naccarato,et al.  Discrepancies between reported food intolerance and sensitization test findings in irritable bowel syndrome patients , 1999, American Journal of Gastroenterology.

[61]  E. Bjornsson,et al.  An exaggerated sensory component of the gastrocolonic response in patients with irritable bowel syndrome , 2001, Gut.

[62]  P. Whorwell,et al.  Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial , 2009, BMJ : British Medical Journal.

[63]  K. Kaukinen,et al.  iagnosing Mild Enteropathy Celiac Disease : A Randomized , Controlled linical Study , 2022 .

[64]  J. Tack,et al.  Role of tension receptors in dyspeptic patients with hypersensitivity to gastric distention. , 2004, Gastroenterology.

[65]  D. Alpers Diet and irritable bowel syndrome , 2006, Current opinion in gastroenterology.

[66]  P. Gibson,et al.  Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome , 2010, Journal of gastroenterology and hepatology.

[67]  C. Niederau,et al.  Cholecystokinin's role in regulation of colonic motility in health and in irritable bowel syndrome. , 1992, Gastroenterology.

[68]  J. Wiley,et al.  Participation of gastric mechanoreceptors and intestinal chemoreceptors in the gastrocolonic response. , 1988, Gastroenterology.

[69]  L. Öhman,et al.  Pathogenesis of IBS: role of inflammation, immunity and neuroimmune interactions , 2010, Nature Reviews Gastroenterology &Hepatology.

[70]  J. Slavin,et al.  Gastrointestinal Effects of Low-Digestible Carbohydrates , 2009, Critical reviews in food science and nutrition.

[71]  Functional Bowel Disorders , 2006 .

[72]  Sarah Stanley,et al.  Hormonal regulation of food intake. , 2005, Physiological reviews.

[73]  S. Bischoff,et al.  Prevalence of adverse reactions to food in patients with gastrointestinal disease , 1996, Allergy.

[74]  P. Whorwell,et al.  Exclusion diets in irritable bowel syndrome: are they worthwhile? , 1987, Journal of clinical gastroenterology.

[75]  P. Whorwell,et al.  Bran and irritable bowel syndrome: time for reappraisal , 1994, The Lancet.

[76]  J. Doar,et al.  Investigation and treatment of endocrinological disorders. , 1972, Lancet.

[77]  A. Zinsmeister,et al.  Diet and Functional Gastrointestinal Disorders: A Population-Based Case—Control Study , 2003, The American Journal of Gastroenterology.

[78]  S. Osganian,et al.  National Institutes of Health Consensus Development Conference: Lactose Intolerance and Health , 2010, Annals of Internal Medicine.

[79]  W. Willett,et al.  Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality , 2010, Annals of Internal Medicine.

[80]  Henry C. Lin,et al.  Normalization of Lactulose Breath Testing Correlates With Symptom Improvement in Irritable Bowel Syndrome: A Double-Blind, Randomized, Placebo-Controlled Study , 2003, American Journal of Gastroenterology.

[81]  M. Elia,et al.  Abnormal colonic fermentation in irritable bowel syndrome , 1998, The Lancet.

[82]  M. Soresi,et al.  Intolerance of cow's milk and chronic constipation in children , 1998, The New England journal of medicine.

[83]  P. Gibson,et al.  Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. , 2006, Journal of the American Dietetic Association.

[84]  P. Moayyedi,et al.  Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. , 2009, Archives of internal medicine.

[85]  M. Manns,et al.  Colonoscopic allergen provocation (COLAP): a new diagnostic approach for gastrointestinal food allergy. , 1997, Gut.

[86]  D. Gorard,et al.  Perceived food and drug allergies in functional and organic gastrointestinal disorders , 2002 .

[87]  R. Heddle,et al.  Increased intestinal permeability in atopic eczema. , 1986, The Journal of investigative dermatology.

[88]  G. D. de’ Angelis,et al.  Duodenal IgE-positive cells and elimination diet responsiveness in children with atopic dermatitis. , 2001, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[89]  P. Vandvik,et al.  Perceived food intolerance in subjects with irritable bowel syndrome – etiology, prevalence and consequences , 2006, European Journal of Clinical Nutrition.

[90]  R. Herva,et al.  Gastrointestinal findings in atopic children , 1980, European Journal of Pediatrics.

[91]  A. Garg,et al.  GASTROENTEROLOGY 2006;131:445–450 Incidence and Epidemiology of Irritable Bowel Syndrome After a Large Waterborne Outbreak of Bacterial Dysentery , 2022 .

[92]  D. Drossman,et al.  AGA technical review on irritable bowel syndrome. , 2002, Gastroenterology.

[93]  K. Schmidt,et al.  The patient's perspective , 2003, Supportive Care in Cancer.

[94]  John J Totman,et al.  Postprandial changes in small bowel water content in healthy subjects and patients with irritable bowel syndrome. , 2010, Gastroenterology.

[95]  P. Moayyedi,et al.  Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis , 2008, BMJ : British Medical Journal.

[96]  J. Tack,et al.  Contribution of different triggers to the gastric accommodation reflex in humans. , 2009, American journal of physiology. Gastrointestinal and liver physiology.

[97]  Jukka Partanen,et al.  Celiac Disease Without Villous Atrophy , 2001, Digestive Diseases and Sciences.

[98]  J. Sabate,et al.  Cholecystokinin octapeptide increases rectal sensitivity to pain in healthy subjects , 2002, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[99]  M. Thabane,et al.  Development and Validation of a Risk Score for Post-Infectious Irritable Bowel Syndrome , 2009, American Journal of Gastroenterology.

[100]  A. Berstad,et al.  Indications of ‘atopic bowel’ in patients with self‐reported food hypersensitivity , 2010, Alimentary pharmacology & therapeutics.

[101]  J. Hunter,et al.  FOOD INTOLERANCE: A MAJOR FACTOR IN THE PATHOGENESIS OF IRRITABLE BOWEL SYNDROME , 1982, The Lancet.

[102]  S. Bentley,et al.  FOOD HYPERSENSITIVITY IN IRRITABLE BOWEL SYNDROME , 1983, The Lancet.

[103]  R. Argenzio,et al.  Short-chain fatty acids induce reversible injury of porcine colon , 1991, Digestive Diseases and Sciences.

[104]  J. Crespo,et al.  Food allergy in adulthood , 2003, Allergy.

[105]  M. Heitkemper,et al.  Diet Triggers Symptoms in Women With Irritable Bowel Syndrome: The Patient’s Perspective , 2001, Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates.

[106]  P. Gibson,et al.  Evidence‐based dietary management of functional gastrointestinal symptoms: The FODMAP approach , 2010, Journal of gastroenterology and hepatology.

[107]  J. Anderson,et al.  The clinical spectrum of food allergy in adults , 1991, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[108]  P. Stumbo,et al.  Ability of the normal human small intestine to absorb fructose: evaluation by breath testing. , 2007, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[109]  C. Niederau,et al.  Effects of CCK‐receptor antagonist on colonic motor activity in dogs , 1995, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[110]  Dockray Gj Luminal sensing in the gut: an overview. , 2003 .

[111]  M. Camilleri,et al.  Effects of an osmotically active agent on colonic transit , 2006, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[112]  Risk factors for irritable bowel syndrome: Role of analgesics and food sensitivities , 2000 .

[113]  N. Read,et al.  Food and hypersensitivity in functional dyspepsia , 2002, Gut.

[114]  Dollery Ct,et al.  Platelets and thrombosis. , 1964, Scottish medical journal.

[115]  T. Wilt,et al.  Systematic Review: Effective Management Strategies for Lactose Intolerance , 2010, Annals of Internal Medicine.

[116]  G. Tsujimoto,et al.  Free fatty acids induce cholecystokinin secretion through GPR120 , 2008, Naunyn-Schmiedeberg's Archives of Pharmacology.

[117]  E. Rozengurt,et al.  Taste receptor signaling in the mammalian gut. , 2007, Current opinion in pharmacology.

[118]  M. Camilleri Integrated upper gastrointestinal response to food intake. , 2006, Gastroenterology.

[119]  Hugh A Sampson,et al.  Update on food allergy. , 2004, The Journal of allergy and clinical immunology.

[120]  P. Ciclitira,et al.  The diagnosis of gluten sensitivity and coeliac disease -the two are not mutually inclusive , 1998, European journal of gastroenterology & hepatology.

[121]  J. Zwetchkenbaum,et al.  Food allergy and the irritable bowel syndrome. , 1988, The American journal of gastroenterology.

[122]  E. Björnsson,et al.  Nutrient‐dependent enhancement of rectal sensitivity in irritable bowel syndrome (IBS) , 2007 .

[123]  H. Kalimo,et al.  Mast cells and IgE in intestinal mucosa in adult atopic dermatitis patients , 1988, The British journal of dermatology.

[124]  R. van der Meer,et al.  Dietary fructo-oligosaccharides and lactulose inhibit intestinal colonisation but stimulate translocation of salmonella in rats , 2003, Gut.

[125]  P. Gumowski,et al.  Irritable bowel syndrome and hypersensitivity to food. , 1985, Annals of allergy.

[126]  M. Benson,et al.  Food-Specific Serum IgG4 and IgE Titers to Common Food Antigens in Irritable Bowel Syndrome , 2005, The American Journal of Gastroenterology.

[127]  D. Schuppan,et al.  Identification of tissue transglutaminase as the autoantigen of celiac disease , 1997, Nature Medicine.

[128]  D. Macdonald,et al.  INTESTINAL PERMEABILITY IN PATIENTS WITH ECZEMA AND FOOD ALLERGY , 1981, The Lancet.