Irritable bowel syndrome
Placebo: More than 25% may improve on placebo (1)
In 80% of patients certain types of foods may aggravate the symptoms. Reduce or avoid factors that make the symptoms worse. It may include becaffeine, fructose and lactose (1)
Low FODMAP diet: This diet is low in poorly absorbed short-chain carbohydrates (1). The diet may reduce diarrhoea, pain, bloating and flatus (1). 4-6 weeks on a low FODMAP diet is enough to consider if a person will respond positively on this diet (1). Three phases: A) Reduced FODMAP for 4-6 weeks, B) Reintroduction of FODMAP foods, and C) personalization of diet based on effects of reintroduction (1).
Probiotic: May benefit some patients with IBS. If a probiotic is tested it is recommended to use it in the dose that the manufacturer recommends for 12 weeks to evaluate the effect (1).
Soluble fiber (eg. beans, oat bran, barley, isphagula) may help with predominantly IBS with constipation, or IBS with alternating constipation and diarrhoea. Fiber dose: Begin with 3-4g/day and gradually increase to avoid bloating (1)
Insoluble fiber: Should be avoided by people with IBS (1)
Regular physical activity may reduce some of the symptoms, including constipation (1)
Lifestyle changes that reduce stress is recommended (1)
EXPLANATION TO EVIDENCE PRESENTATION
Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD
Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE
Evidence based on randomized controlled trials is written in plain font
Evidence based on observational / cohort studies is written in CURSIVE
Figure: Evidence pyramid