IBS nutrition management strategies.pdf - 545329 research-article2014 PENXXX10.1177\/ of Parenteral and Enteral Nutrition X(X)Mullin et al Tutorial

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Journal of Parenteral and Enteral Nutrition Volume 38 Number 7 September 2014 781–799 © 2014 American Society for Parenteral and Enteral Nutrition DOI: 10.1177/0148607114545329 jpen.sagepub.com hosted at online.sagepub.com Tutorial Irritable bowel syndrome (IBS) is a disorder that affects 10%–15% of the U.S. population and is characterized by altered bowel movements and abdominal pain. 1 IBS is cur- rently diagnosed according to the Rome III criteria, but for many clinicians, it is a diagnosis of exclusion since other con- ditions such as celiac disease may have overlapping symp- toms (Table 1). 2 IBS can occur at any age but mainly presents in young adults. It is rare for IBS to first manifest after age 50 years. 1 Most IBS experts agree that a pathophysiologic and/or mental stressor is a trigger for the vast majority of cases. IBS is more commonly identified in women than in men by 2:1 in Western countries and is associated with a poor quality of life, adverse economic impact related to absenteeism from work, and loss of productivity, with healthcare costs mea- sured in the billions of dollars annually. 3,4 IBS is associated with a number of disorders within the digestive tract (ie, celiac disease) but also has numerous extraintestinal manifes- tations (ie, fibromyalgia, chronic pelvic pain, interstitial cys- titis, chronic fatigue syndrome, etc). 1 The pathophysiology of IBS is multifaceted and is described in more detail below, but it involves a number of pathophysi- ologic disruptions in the gut-brain axis. It is important to note that these mechanisms influence the expression of the disease but are not universally operative in all patients or are patho- gnomic of IBS. A number of digestive tract symptoms are asso- ciated with IBS, including constipation, diarrhea, pain and/or discomfort, distension, and flatulence. There are 3 phenotypic subsets of IBS: constipation-predominant IBS (IBS-C), diarrhea-predominant IBS (IBS-D), and mixed (IBS-M). Dietary modifications are among the primary treatments to alleviate gas- trointestinal (GI) symptoms and improve overall health. 5 Pathophysiology of IBS The pathophysiology of IBS is highly complex and involves a number of factors that interact to produce chronic symptoms and psychological comorbidity, as shown in Figure 1. IBS is a 545329 PEN XX X 10.1177/0148607114545329Journal of Parenteral and Enteral Nutrition X(X) Mullin et al research-article 2014 From the 1 Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; 2 Department of Dietetics and Human Nutrition, La Trobe University, Bundoora, Victoria, Australia; 3 Nutrition Therapy Specialist/Consultant, Carrollton, Texas; and 4 Division of Gastroenterology, Hepatology and Nutrition, Brody School of Medicine and Department of Nutrition Science, East Carolina University, Greenville, North Carolina.
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