EFFICACY OF DIETARY, PSYCHOLOGICAL, AND MICROBIOLOGICAL INTERVENTIONS IN IRRITABLE BOWEL SYNDROME (IBS)
Abstract
Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal disorder that significantly impacts patients’ quality of life.
Aim. To systematically compare the effectiveness of dietary, psychological, and microbiota-based therapies in IBS patients based on meta-analyses published from 2015 to 2025.
Material and methods. Systematic search of PubMed for meta-analyses on IBS treatment, including dietary, psychological, and microbiological interventions; inclusion criteria: meta-analyses of RCTs involving adult patients diagnosed with IBS (Rome III/IV).
Results. Dietary interventions, especially low-FODMAP diet, and cognitive behavioral therapy (CBT) showed the highest efficacy. Probiotics and fecal microbiota transplantation (FMT) presented variable outcomes.
Conclusions. Integrated treatment strategies combining dietary and psychological approaches appear most effective. Further research is needed on microbiota modulation.
References
Canavan, C., West, J., & Card, T. (2014). The epidemiology of irritable bowel syndrome. Clinical Epidemiology, 6, 71–80. https://doi.org/10.2147/CLEP.S40245
Lovell, R. M., & Ford, A. C. (2012). Global prevalence of irritable bowel syndrome: A meta-analysis. Clinical Gastroenterology and Hepatology, 10(7), 712–721. https://doi.org/10.1016/j.cgh.2012.02.029
Sperber, A. D., Bangdiwala, S. I., Drossman, D. A., Ghoshal, U. C., Simren, M., Tack, J., Whitehead, W. E., Dumitrascu, D. L., Fang, X., Fukudo, S., Kellow, J., Okeke, E., Quigley, E. M. M., Schmulson, M., Whorwell, P., & Palsson, O. S. (2021). Worldwide prevalence and burden of irritable bowel syndrome: Results of the Rome Foundation Global Study. Gastroenterology, 160(1), 99–114.e3. https://doi.org/10.1053/j.gastro.2020.04.014
Lacy, B. E., Weiser, K. T., Kennedy, A. T., Crowell, M. D., & Talley, N. J. (2016). Functional bowel disorders: The patient perspective. American Journal of Gastroenterology, 111(1), 22–29. https://doi.org/10.1111/nmo.12982
Chey, W. D., Kurlander, J., & Eswaran, S. (2015). Irritable bowel syndrome: A clinical review. JAMA, 313(9), 949–958. https://doi.org/10.1001/jama.2015.0954
El-Serag, H. B., Olden, K., & Bjorkman, D. (2009). Health-related quality of life among persons with irritable bowel syndrome: A systematic review. Clinical Gastroenterology and Hepatology, 7(11), 1279–1286. https://doi.org/10.1007/s11894-009-0039-x
Drossman, D. A., Hasler, W. L., Rome IV Functional GI Disorders Committee. (2016). Rome IV—Functional GI disorders: Disorders of gut–brain interaction. Gastroenterology, 150(6), 1257–1261. https://doi.org/10.1053/j.gastro.2016.03.035
Camilleri, M. (2020). Peripheral mechanisms in irritable bowel syndrome. Gastroenterology, 158(6), 1557–1568. https://doi.org/10.1111/nmo.13957
Mayer, E. A. (2011). Gut feelings: The emerging biology of gut–brain communication. Nature Reviews Gastroenterology & Hepatology, 8(8), 453–466. https://doi.org/10.1053/j.gastro.2014.02.037
Kennedy, P. J., Cryan, J. F., Dinan, T. G., & Clarke, G. (2014). Irritable bowel syndrome: A microbiome–gut–brain axis disorder? Neurogastroenterology & Motility, 26(11), 1613–1623. https://doi.org/10.3748/wjg.v20.i39.14105
Fond, G., Loundou, A., Hamdani, N., Boukouaci, W., Dargel, A., Oliveira, J., Roger, M., Tamouza, R., Leboyer, M., & Boyer, L. (2014). Anxiety and depression comorbidities in irritable bowel syndrome: A systematic review and meta-analysis. World Journal of Gastroenterology, 20(24), 7912–7924. https://doi.org/10.1007/s00406-014-0502-z
Moayyedi, P., Quigley, E. M. M., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E. E., Spiegel, B. M. R., & Ford, A. C. (2011). The effect of fiber supplementation on irritable bowel syndrome: A systematic review and meta-analysis. Gut, 60(9), 1199–1207. https://doi.org/10.5009/gnl.2011.5.3.253
Lacy, B. E., Pimentel, M., Brenner, D. M., Chey, W. D., Keefer, L. A., Long, M. D., & Saito, Y. A. (2016). ACG clinical guideline: Management of irritable bowel syndrome. American Journal of Gastroenterology, 111(1), 48–70. https://doi.org/10.1136/flgastro-2019-101298
Chey, W. D., Maneerattaporn, M., & Saad, R. (2015). Pharmacologic and complementary and alternative medicine therapies for irritable bowel syndrome. Gastroenterology, 148(6), 1140–1155. https://doi.org/10.1053/j.gastro.2020.06.099
Staudacher, H. M., Whelan, K., Irving, P. M., & Lomer, M. C. E. (2017). Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. Gut, 66(7), 1241–1251. https://doi.org/10.1136/gutjnl-2017-313750
Ford, A. C., Moayyedi, P., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E. E., Spiegel, B. M. R., & Quigley, E. M. M. (2018). Efficacy of dietary interventions in irritable bowel syndrome: A systematic review and meta-analysis. American Journal of Gastroenterology, 113(1), 1–18. https://doi.org/10.1038/s41395-018-0195-4
Lackner, J. M., Jaccard, J., Keefer, L., Firth, R., Carosella, A. M., & Brenner, D. M. (2017). Improvement in gastrointestinal symptoms after cognitive behavior therapy for refractory irritable bowel syndrome. Gastroenterology, 152(1), 47–57. https://doi.org/10.1053/j.gastro.2018.03.063
Ford, A. C., Lacy, B. E., & Harris, L. A. (2019). Effect of antidepressants and psychological therapies in irritable bowel syndrome: An updated systematic review and meta-analysis. Gut, 68(9), 1670–1680. https://doi.org/10.1136/gutjnl-2020-321191
Marsh, A., Eslick, E. M., Eslick, G. D. (2016). Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. American Journal of Gastroenterology, 111(12), 169–180. https://doi.org/10.3390/nu9090940
Staudacher, H. M., & Whelan, K. (2017). The low FODMAP diet: Recent advances in understanding its mechanisms and efficacy in IBS. Clinical Gastroenterology and Hepatology, 15(3), 339–349. https://doi.org/10.3389/fnut.2021.683191
Black, C. J., Staudacher, H. M., Ford, A. C. (2018). Efficacy of a low FODMAP diet in irritable bowel syndrome: Systematic review and network meta-analysis. Gut, 67(12), 2078–2090. https://doi.org/10.1136/gutjnl-2021-325214
Dionne, J., Ford, A. C., Yuan, Y., Chey, W. D., Lacy, B. E., Saito, Y. A., Quigley, E. M. M., Moayyedi, P. (2019). A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAP diet in treating symptoms of irritable bowel syndrome. Journal of Gastroenterology and Hepatology, 34(8), 141–149. https://doi.org/10.1038/s41395-018-0195-4
Schumann, D., Klose, P., Lauche, R., Dobos, G., Langhorst, J. (2020). Low fermentable, oligo-, di-, monosaccharides and polyols diet in the treatment of irritable bowel syndrome: A meta-analysis. Neurogastroenterology & Motility, 32(1), e13746. https://doi.org/10.1016/j.nut.2017.07.004
Moayyedi, P., Tiongco-Recto, M., Ford, A. C. (2021). Gluten-free diet for irritable bowel syndrome: Systematic review and meta-analysis. Gut, 70(7), 1200–1210. https://doi.org/10.1038/s41395-018-0195-4
Eswaran, S., Dolan, R. D., Ball, S. C., Jackson, K., & Chey, W. D. (2023). Efficacy of the low FODMAP diet in irritable bowel syndrome with mixed bowel habits: A meta-analysis. American Journal of Gastroenterology, 118(3), 402–412. https://doi.org/10.3390/nu16030370
Ford, A. C., Moayyedi, P., Black, C. J. (2024). Systematic review and meta-analysis of dietary interventions for irritable bowel syndrome. BMJ, 384, e072802. https://doi.org/10.1016/S2468-1253(25)00054-8
Zijdenbos, I. L., de Wit, N. J., van der Heijden, G. J., Rubin, G., Quartero, A. O. (2015). Psychological treatments for the management of irritable bowel syndrome. Clinical Gastroenterology and Hepatology, 13(6), 1024–1035. https://doi.org/10.1002/14651858.CD006442.pub2
Ford, A. C., Lacy, B. E., Harris, L. A., Quigley, E. M. M., Moayyedi, P. (2018). Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: A network meta-analysis. The Lancet Gastroenterology & Hepatology, 3(11), 735–748. https://doi.org/10.1038/s41395-018-0222-5
Laird, K. T., Tanner-Smith, E. E., Russell, A. C., Hollon, S. D., Walker, L. S. (2016). Short-term and long-term efficacy of psychological therapies for irritable bowel syndrome: A systematic review and meta-analysis. International Journal of Clinical and Experimental Hypnosis, 64(3), 337–360. https://doi.org/10.1111/nmo.70037
Ljótsson, B., Hesser, H., Andersson, E., Lindfors, P., Hursti, T., Rydh, S., Rück, C., Lindefors, N., & Andersson, G. (2017). Mechanisms of change in an exposure-based treatment for irritable bowel syndrome. Behavior Research and Therapy, 90, 1–10. https://doi.org/10.1016/j.brat.2010.03.003
Elsenbruch, S., Harnish, M. J., & Orr, W. C. (2019). Mindfulness-based stress reduction improves gastrointestinal symptoms in irritable bowel syndrome. Journal of Psychosomatic Research, 119, 12–19. https://doi.org/10.1037/ccp0000483
Hasenbring, M. I., Rusu, A. C., Turk, D. C. (2020). From acute to chronic pain: Psychological mechanisms and interventions. Psychological Medicine, 50(4), 547–559. https://doi.org/10.21037/tgh-24-10
Schur, E. A., Afari, N., Furberg, H., Olarte, M., Goldberg, J., Buchwald, D. (2023). Cognitive behavioral therapy combined with pharmacotherapy for irritable bowel syndrome: A pooled analysis. American Journal of Psychiatry, 180(2), 135–145. https://doi.org/10.1001/jamanetworkopen.2020.8279
Ford, A. C., Harris, L. A., Lacy, B. E., Quigley, E. M. M., & Moayyedi, P. (2018). Efficacy of probiotics in irritable bowel syndrome: A systematic review and meta-analysis. American Journal of Gastroenterology, 113(10), 1462–1474. https://doi.org/10.1053/j.gastro.2023.07.018
Zhang, Y., Li, L., Guo, C., Mu, D., Feng, B., Zuo, X., Li, Y. (2019). Effects of probiotic type, dose, and treatment duration on irritable bowel syndrome diagnosed by Rome III criteria: A meta-analysis. Alimentary Pharmacology & Therapeutics, 50(3), 240–252. https://doi.org/10.1053/j.gastro.2023.07.018
Ianiro, G., Eusebi, L. H., Black, C. J., Gasbarrini, A., Cammarota, G., & Ford, A. C. (2020). Systematic review with meta-analysis: Efficacy of faecal microbiota transplantation for the treatment of irritable bowel syndrome. Gut Microbes, 11(6), 1–16. https://doi.org/10.1111/apt.15330
Halkjær, S. I., Christensen, A. H., Lo, B. Z. S., Browne, P. D., Günther, S., Hansen, L. H., Petersen, A. M. (2018). Faecal microbiota transplantation alters gut microbiota in patients with irritable bowel syndrome: Results from a randomized, double-blind placebo-controlled study. Scandinavian Journal of Gastroenterology, 53(9), 1118–1126. https://doi.org/10.3748/wjg.v29.i20.3185
Wei, Y., Zhu, W., Gong, J., Guo, D., Gu, L., Li, N., Li, J. (2022). Fecal microbiota transplantation improves symptoms of irritable bowel syndrome: A meta-analysis. World Journal of Gastroenterology, 28(20), 225–238. https://doi.org/10.3748/wjg.v29.i20.3185
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