Irritable_bowel_syndrome_Role_of_food_in.pdf - Journal of Digestive Diseases 2009 10 237\u2013246 doi 10.1111\/j.1751-2980.2009.00392.x Irritable bowel

Irritable_bowel_syndrome_Role_of_food_in.pdf - Journal of...

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Irritable bowel syndrome: Role of food in pathogenesis and management Ashraf 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, Ireland Patients with the irritable bowel syndrome (IBS) com- monly report the precipitation of symptoms on food ingestion. Though the role of dietary constituents in IBS has not been extensively studied, food could con- tribute to symptom onset or even the causation of IBS through a number of mechanisms. First, the physi- ological response of the intestine to food ingestion could precipitate symptoms in predisposed individu- als; second, there is some evidence that allergy or intolerance to a particular food can produce IBS-like symptoms, third, certain foods may alter the compo- sition of the luminal milieu, either directly or indi- rectly through effects on bacterial metabolism, and thus induce symptoms and, finally, IBS may develop following exposure to food-borne pathogens. Anti- cipatory, psychological factors generated by previous negative experiences with food ingestion or other factors may also contribute though their contribution has been scarcely quantified. Not surprisingly, there is considerable interest in the potential roles of diet and food supplements in the therapy of IBS; for the most part, the evidence base for such recommendations remains slim though certain probiotics show consid- erable promise. KEY WORDS: enteric microbiota, food, food allergy, food intolerance, irritable bowel syndrome, probiotics. IBS: PREVALENCE AND PATHOGENESIS Irritable bowel syndrome (IBS) is one of the most common disorders encountered in modern medicine: community surveys in western Europe and North America suggesting a prevalence of around 10% in the adult population. 1 It should be stressed, in addition, that IBS appears to be common worldwide regardless of geography or socioeconomic status. There is no single specific diagnostic test for IBS: its definition relies, therefore, either on the exclusion of diseases that may share its symptomatology in whole or in part, or on the application of symptom-based criteria whose integrity has been validated in cross-sectional and longitudinal studies. The cardinal symptoms of IBS are abdominal pain or discomfort and bowel dys- function. Typically, these are interrelated such that, for example, an affected patient may report that his, or more likely her, symptoms worsen when constipated, only to be relieved once a bowel movement has been achieved. In clinical research most studies apply the definitions enshrined in the Rome criteria, whose third iteration (Rome III) was released in early 2006 and defined IBS as: Recurrent abdominal pain or discomfort (an uncom- fortable sensation not described as pain) at least 3 days per month in the last 3 months associated with two or more of the following: Correspondence to: Eamonn MM QUIGLEY, Department of Medicine, Clinical Sciences Building, Cork University Hospital, Cork, Ireland.
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