Medications that improve diarrhea (e.g., loperamide, probiotics) or constipation (e.g., fiber supplements, laxatives) are used as the first-line IBS therapies to improve altered bowel habits but offer little benefit for abdominal pain, bloating, and psychosocial problems ( 1, 2). Irritable bowel syndrome has been conceptualized as a brain–gut disorder ( 4), which is also associated with poor quality of life, impaired social function ( 5), and psychological-psychiatric conditions, such as anxiety and depression ( 6– 8). IBS is usually categorized into subtypes according to predominant bowel habits: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), mixed IBS (IBS-M), or unsubtyped IBS (IBS-U) ( 1– 3). The diagnosis of IBS is based on the association of recurrent abdominal pain with altered bowel habits, namely, diarrhea and/or constipation, in the absence of organic diseases, such as inflammatory bowel disease or colon cancer ( 2). In some Western countries, the prevalence of irritable bowel syndrome (IBS) is around twice as high in females than in males, which may be higher in Asian countries ( 1). Irritable bowel syndrome is one of the most prevalent chronic gastrointestinal diseases, with a prevalence of ~7–21% ( 1, 2). Systematic Review Registration: CRD42021235843. The efficacy for IBS-D patients can also be more pronounced. The overall quality of the data was “moderate” for “global improvement of IBS symptom,” “stool consistency,” “stool consistency for IBS with diarrhea (IBS-D),” and “stool frequency for IBS-D,” and “low” or “very low” for other outcomes according to GRADE criteria.Ĭonclusion: An LFD is effective in reducing the global symptoms and improving the bowel habits of adult IBS patients. An LFD was associated with the improvement of global symptoms, improvement of stool consistency [ n = 434 Mean difference (MD) = −0.25 95% CI −0.44 to −0.06 I 2= 19%), and a reduction trend of stool frequency ( n = 434 MD = −0.28 95% CI −0.57 to 0.01 I 2 = 68%) compared with control interventions. After full-text screening, a total of 10 studies were eligible for the systematic review and were subsequently used to compare an LFD with various control interventions in 511 participants. Results: A total of 2,768 citations were identified. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The bias of publication was assessed based on Egger's regression analysis. The risk of bias was assessed using Risk of Bias Tool 2 (RoB 2). Data were synthesized as the relative risk of global symptoms improvement, mean difference of IBS Severity Scoring System (IBS-SSS) score, sub-items of IBS-SSS irritable bowel syndrome-related quality of life (IBS-QOL), hospital anxiety and depression scale (HADS), stool consistency/frequency, and body mass index (BMI) using a random effects model. a normal IBS or usual diet and assessed changes of IBS symptoms were included in the search. Two independent reviewers also performed eligibility assessments and data extraction. Two independent reviewers screened citations and a third reviewer resolved disagreements. The searches in each database were conducted from the inception of the database to February 2021. Methods: A search of the literature for RCTs that assessed the efficacy of an LFD in treating IBS patients was conducted using the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science. Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to explore the efficacy of a low-FODMAP diet (LFD) in alleviating the symptoms of IBS. Background: A low-fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) diet has been reported to be associated with improving the symptoms of irritable bowel syndrome (IBS) however, its efficacy as evaluated by different studies remains controversial.
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