From the Guidelines
Irritable Bowel Syndrome (IBS) can be triggered by stress, intercurrent illnesses, drugs, and the act of eating, as stated in the British Society of Gastroenterology guidelines 1.
Triggers of IBS
The triggers of IBS can be multifaceted, including:
- Stress, which can exacerbate symptoms through the gut-brain connection
- Intercurrent illnesses, which can disrupt the normal functioning of the gut
- Certain medications, such as antibiotics, which can alter the gut microbiome
- The act of eating, which can trigger symptoms in some individuals
Pathophysiology of IBS
The pathophysiology of IBS is complex and involves disordered motility, visceral hypersensitivity, and altered mucosal, immune, and microbial integrity, as discussed in the Nature Reviews Gastroenterology and Hepatology article 1.
Management of IBS
To manage IBS, it is essential to consider a multidisciplinary approach, including medical, dietary, and behavioral interventions, as outlined in the AGA Clinical Practice Update on the role of diet in IBS 1. This may involve:
- Keeping a food and symptom diary to identify personal triggers
- Implementing stress management techniques, such as meditation or yoga
- Engaging in regular physical activity to improve gut motility
- Discussing medications, such as antispasmodics or antidepressants, with a healthcare provider to manage specific symptoms.
From the Research
Triggers of IBS
- Foods are not generally considered a cause of IBS, but rather symptom-triggering factors 2
- Dietary components, such as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), can induce IBS symptoms 2, 3, 4
- Gluten-free and low FODMAP diets have been shown to be effective in reducing IBS symptoms 2, 3, 5, 6
- Wheat intolerance may be a trigger for some IBS patients, possibly due to its high FODMAP content or non-specific immune activation 4, 6
Specific Foods and Compounds
- Rapidly fermented, poorly absorbed carbohydrates can produce gaseous distension and short-chain fatty acids, leading to symptoms in IBS patients 4
- FODMAPs, such as those found in wheat, can trigger symptoms in some IBS patients 3, 4, 5
- Gluten may also play a role in triggering symptoms in some IBS patients, although the exact mechanisms are not fully understood 6
Dietary Approaches
- A low FODMAP diet, combined with a gluten-free diet, has been shown to be effective in reducing IBS symptoms and improving quality of life 5
- The implementation of a gluten-free diet should be performed by a dietitian with a specialist interest in IBS, and may be achieved through group sessions 6
- A personalized approach to diet, taking into account individual triggers and intolerances, may be the most effective way to manage IBS symptoms 3, 4