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Irritable bowel syndrome: Role of food in pathogenesisand managementAshraf MORCOS,* Ted DINAN†& Eamonn MM QUIGLEY‡*Department of Gastroenterology and Internal Medicine, Midwestern Regional Hospital, Limerick,†Department of Psychiatry, University College Cork, and‡Department of Medicine, Cork University Hospital,Cork, IrelandPatients with the irritable bowel syndrome (IBS) com-monly report the precipitation of symptoms on foodingestion. Though the role of dietary constituents inIBS has not been extensively studied, food could con-tribute to symptom onset or even the causation of IBSthrough a number of mechanisms. First, the physi-ological response of the intestine to food ingestioncould precipitate symptoms in predisposed individu-als; second, there is some evidence that allergy orintolerance to a particular food can produce IBS-likesymptoms, third, certain foods may alter the compo-sition of the luminal milieu, either directly or indi-rectly through effects on bacterial metabolism, andthus induce symptoms and, finally, IBS may developfollowing exposure to food-borne pathogens. Anti-cipatory, psychological factors generated by previousnegative experiences with food ingestion or otherfactors may also contribute though their contributionhas been scarcely quantified. Not surprisingly, there isconsiderable interest in the potential roles of diet andfood supplements in the therapy of IBS; for the mostpart, the evidence base for such recommendationsremains slim though certain probiotics show consid-erable promise.KEY WORDS:enteric microbiota, food, food allergy, food intolerance, irritable bowel syndrome, probiotics.IBS: PREVALENCE AND PATHOGENESISIrritable bowel syndrome (IBS) is one of the mostcommon disorders encountered in modern medicine:community surveys in western Europe and NorthAmerica suggesting a prevalence of around 10% in theadult population.1It should be stressed, in addition,that IBS appears to be common worldwide regardlessof geography or socioeconomic status. There is nosingle specific diagnostic test for IBS: its definitionrelies, therefore, either on the exclusion of diseasesthat may share its symptomatology in whole or inpart, or on the application of symptom-based criteriawhose integrity has been validated in cross-sectionaland longitudinal studies. The cardinal symptoms ofIBS are abdominal pain or discomfort and bowel dys-function. Typically, these are interrelated such that, forexample, an affected patient may report that his, ormore likely her, symptoms worsen when constipated,only to be relieved once a bowel movement has beenachieved. In clinical research most studies apply thedefinitions enshrined in the Rome criteria, whosethird iteration (Rome III) was released in early 2006and defined IBS as:Recurrent abdominal pain or discomfort (an uncom-fortable sensation not described as pain) at least3 days per month in the last 3 months associated withtwo or more of the following:Correspondence to: Eamonn MM QUIGLEY, Department of Medicine,Clinical Sciences Building, Cork University Hospital, Cork, Ireland.