Are adverse food reactions linked to irritable bowel syndrome?

SUMMARYAim: To determine how clusters (groups) of patients with respect to symptoms compare with a clinical diagnosis in patients with irritable bowel syndrome and non-ulcer dyspepsia. Methods: All patients who attended a gastroenterology practice at Nepean Hospital were included in the study. All patients received the previously validated Bowel Disease Questionnaire, and were independently assessed by the gastroenterologist. Factor analysis and a k-means cluster analysis were completed. Results: The study population comprised 897 patients [320 males (36%) and 577 females (64%)]. Factor analysis identified nine symptom factors: (1) diarrhoea; (2) constipation; (3) dysmotility; (4) dyspepsia/reflux; (5) nausea/vomiting; (6) bowel; (7) meal-related pain; (8) weight loss; and (9) abdominal pain. A k-means cluster analysis identified seven distinct subject groups, which included an undifferentiated group: (1) diarrhoea; (2) meal-related pain; (3) abdominal pain; (4) faecal indicators; (5) nausea/vomiting/weight loss; and (6) constipation. The majority of irritable bowel syndrome patients fitted into two cluster groups [diarrhoea (25%) and constipation (20%)], whereas those with non-ulcer dyspepsia predominantly fitted into the undifferentiated cluster (34%) and the nausea/vomiting cluster (18%). Conclusion: This study supports the concept of symptom subgroups, including the subdivision of patients into diarrhoea-and constipation-predominant irritable bowel syndrome.

Section: Discussionmentioning

confidence: 99%

Empirically derived symptom sub‐groups correspond poorly with diagnostic criteria for functional dyspepsia and irritable bowel syndrome. A factor and cluster analysis of a patient sample

Eslick

Howell

Hammer

et al. 2003

“…Our findings do not exclude the possibility that food allergy or intolerance leads to symptom production in functional disorders. However, there is little direct evidence for this, 18 , 19 and the finding that patients with functional diagnoses also report drug allergies suggests that the perceived food intolerances and allergies are not the primary problem in functional gastrointestinal symptom production.…”

Section: Discussionmentioning

confidence: 99%

Perceived food and drug allergies in functional and organic gastrointestinal disorders

Bhat

Harper

Gorard

2002

“…Elimination diets in IBS have yielded conflicting results 181 . Identifying offending dietary substances, e.g.…”

Section: Clinical Evidencementioning

confidence: 99%

Meta‐analysis: the treatment of irritable bowel syndrome

Lesbros-Pantoflickova

Michetti

Fried

et al. 2004

176

120

Summary To evaluate therapies available for the treatment of irritable bowel syndrome, and provide consensus recommendations for their use, a total of 51 double‐blind clinical trials using bulking agents, prokinetics, antispasmodics, alosetron, tegaserod and antidepressants were selected. The quality of studies was assessed using 5‐point scale. Meta‐analyses were performed on all studies, and on ‘high‐quality studies’. The efficacy of fibre in the global irritable bowel syndrome symptoms relief (OR: 1.9; 95% CI:1.5–2.4) was lost after exclusion of low‐quality trials (OR: 1.4; 95% CI: 1.0–2.0, P = 0.06). When excluding the low‐quality trials, an improvement of global irritable bowel syndrome symptoms with all antispasmodics (OR: 2.1; 95% CI:1.8–2.9) was maintained only for octylonium bromide, but on the basis of only two studies. Antidepressants were effective (OR: 2.6, 95% CI: 1.9–3.5), even after exclusion of low‐quality studies (OR: 1.9, 95% CI: 1.3–2.7). Alosetron (OR: 2.2; 95% CI: 1.9–2.6) and tegaserod (OR: 1.4; 95% CI: 1.2–1.5) showed a significant effect in women. We recommend the use of tegaserod for women with irritable bowel syndrome with constipation and alosetron for women with severe irritable bowel syndrome with diarrhoea. Antidepressants can be beneficial for irritable bowel syndrome with diarrhoea patients with severe symptoms. Loperamide can be recommended in painless diarrhoea. Evidence is weak to recommend the use of bulking agents in the treatment of irritable bowel syndrome with constipation.