AGA Recommends Professional Dietary Guidance for Patients With IBS

Patients with motivation to change and insight into their food-related gastrointestinal symptoms should ideally be prescribed dietary advice to manage irritable bowel syndrome (IBS), advises an American Gastroenterological Association Clinical Practice Update published in the journal Gastroenterology.

“To optimize the quality of teaching and clinical response, referral to a registered dietitian nutritionist (RDN) should be made to patients who are willing to collaborate with a RDN and patients who are not able to implement beneficial dietary changes on their own,” the update recommends. “If a gastrointestinal RDN is not available, other resources can assist with implementation of diet interventions.”

The practice update includes 9 best practice advice statements for clinical gastroenterologists regarding the role of diet in IBS. While dietary advice is recommended overall, the recommendation is not universal and should take into account patient factors such as food insecurity, mental and physical health conditions, and whether culprit foods are even being consumed.

For patients who do not improve with dietary changes or for whom specific dietary interventions are not applicable, treatment alternatives such as medication or another form of therapy should be considered, the update recommends.

Other guidance in the update touches on preparing for RDN consultation, efficacy of soluble fiber, and evidence for interventions such as the low–fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) diet and a gluten-free diet. Mounting evidence supports the FODMAP diet, according to the update, while randomized controlled trials are mixed when it comes to gluten-free eating.

“At present, it remains unclear whether a gluten-free diet is of benefit to patients with IBS,” the update states.

—Jolynn Tumolo

Reference

Chey WD, Hashash JG, Manning L, Chang L. AGA Clinical Practice Update on the role of diet in irritable bowel syndrome: expert review. Gastroenterology. 2022;162(6):1737-1745.e5.