Background: Different food items are made responsible for irritable bowel syndrome (IBS) symptoms, but the physiopathology of IBS remains unclear. Aims: During a meeting in Nice, France, experts of the European Working Team of the IBiS Club discussed selected data regarding the relationships between alimentation, food items (including fibers) and IBS symptoms. Methods/Results: Food allergy remains a difficult diagnosis, but medical and general history, presence of general symptoms such as skin rash, and hypersensitivity tests may help in achieving a positive diagnosis. On the other hand, food intolerance is more confusing because of the subjectivity of the relationship between ingestion of certain foods and the appearance of clinical symptoms. Different food items which are commonly implicated in adverse reactions mimicking IBS were found to be stimulants for the gut, suggesting that patients with predominant diarrhea IBS have to be carefully questioned about consumption of different kinds of food (i.e., coffee, alcohol, chewing gum, soft drinks) and not only on lactose ingestion. Gas production is discussed on the basis of retention of intestinal gas as well as on malabsorption of fermentable substrates. The role of a large amount of this kind of substrate reaching the colon is suggested as a potential mechanism of IBS-type symptoms in overeating patients. Regarding the role of fiber in IBS, the expert group concluded that fibers are not inert substances and that they could trigger pain or bloating in some IBS patients. Conclusion: Despite numerous reviews on this subject, it is very difficult to give general dietary advice to IBS patients, but dieteticians may have a positive role in managing such patients.

Keywords:
Irritable bowel syndrome, Alimentation, Food allergy, Food intolerance, Lactose intolerance, Gas production, Overeating, Fibers
1.
Whitehead WE, Crowell MD, Bosmajian L, Zonderman A, Costa PT Jr, Benjamin C et al: Existence of irritable bowel syndrome supported by factor analysis of symptoms in two community samples. Gastroenterology 1990;98:336–340.
2.
Crowe SE, Perdue MH: Gastrointestinal food hypersensitivity: Basic mechanisms of pathophysiology. Gastroenterology 1992;103:1075–1095.
3.
Kardinaal AFM: Epidemiology of food allergy and food; in Somoguyi JC, Müller HR, Ockhuizen TH (eds): Food Allergy and Food Intolerance. Nutritional Aspects and Developments. Basel, Karger, 1991, pp 1–05.
4.
Vatn MH, Grimstad IA, Thorsen L, Kittang E, Refnin I, Malt U et al: Adverse reactions to food: Assessment by double-blind, placebo-controlled food challenge and clinical, psychosomatic and immunologic analysis. Digestion 1995;56:421–428.
5.
Jacobsen MB, Kittang E, Aukrust P, Bratlie J, Vatn MH: Food intolerance – An inflammatory disease? Gastroenterology 1996;110:A685.
6.
Bischoff SC, Mayer J, Wedenmeyer J et al: Colonoscopic allergen provocation (COLAP): A new approach for gastrointestinal food allergy. Gut 1997;40:745–753.
7.
Bischoff SC, Mayer J, Meier PN, Zeck-Kapp G, Manns MP: Clinical significance of the colonoscopic allergen provocation test. Int Arch Allergy Immunol 1997;113:348–351.
8.
Young E, Stoneham MD, Petruckevitch A, Barton J, Rona R: A population study of food intolerance. Lancet 1994;343:1127–1130.
9.
Hunter JO, Workman EM, Alun Jones V: Dietary studies; in Gibson PR, Jewell DP (eds): Topics in Gastroenterology 12. Oxford, Blackwell Scientific, 1985, pp 305–313.
10.
Nanda R, James R, Smith H, Dudley CRK, Jewell DP: Food intolerance and the irritable bowel syndrome. Gut 1989;30:1099–1104.
11.
Bentley SJ, Pearson DJ, Rix KJ: Food hypersensitivity in irritable bowel syndrome. Lancet 1983;ii:295–297.
12.
McKee AM, Prior A, Whorwell PJ: Exclusion diets in irritable bowel syndrome: Are they worthwhile? J Clin Gastroenterol 1987;9:526–528.
13.
Niec AM, Talley NJ: Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol 1998;93:2184–2190.
14.
Turnberg LA: Coffee and the gastrointestinal tract. Gastroenterology 1978;75:529–530.
15.
Rao SSC, Welcher K, Stumbo P: Does coffee affect bowel function? Gastroenterology1996;110:A741.
16.
Brown SR, Cann PA, Read NW: Effect of coffee on distal colon function. Gut 1990;31:450–453.
17.
Rao SSC, Welcher K, Zimmerman B, Stumbo P: Is coffee a colonic stimulant? Eur J Gastroenterol Hepatol 1998;10:L13–L18.
18.
Lieb J: Prostaglandin synthesis inhibitors in prophylaxis of coffee intolerance. JAMA 1980;32:243.
19.
Wald A, Back C, Bayless TM: Effect of coffee on the human small intestine. Gastroenterology 1976;71:738–742.
20.
Wagner SM, Mekhjian HS, Caldwell JH, Thomas FB: Effects of caffeine and coffee on fluid transport in the small intestine. Gastroenterology 1978;75:379–381.
21.
Roth JA., Ivy AC: The effects of caffeine upon gastric secretion in the dog, cat and man. Am J Physiol 1944;141:454–461.
22.
Acquaviva F, De Francesco A, Andriulli A et al: Effect of regular and decaffeinated coffee on serum gastrin level. J Clin Gastroenterol 1986;8:150–153.
23.
Addolorato G, Montalto M, Capristo E, Certo M, Stefanini GF, Gasbarrini G: Influence of alcohol on gastrointestinal motility: Breath hydrogen testing in orocaecal transit tile of chronic alcoholics, social drinkers and teetotaler subjects. Hepatogastroenterology 1997;44:1076–1081.
24.
Huppe D, Tonissen R, Hofius M, Kuntz HD, May B: Effect of chronic alcohol drinking and liver cirrhosis on oro-cecal transit time (H2 breath test). Z Gastroenterol 1989;27:624–628.
25.
Bouchoucha M, Nalpas B, Berger M, Cugnenc PH, Barbier JP: Recovery from disturbed colonic transit time after alcohol withdrawal. Dis Colon Rectum 1991;34:111–114.
26.
Charles F, Evans DF, Castillo FD, Wingate DL: Daytime ingestion of alcohol alters nighttime jejunal motility in man. Dig Dis Sci 1994;39:51.
27.
Talley NJ, Zinsmeister AR, Melton LJ 3rd: Irritable bowel syndrome in a community: Symptom subgroups, risk factors and healthcare utilization. Am J Epidemiol 1995;142:76–83.
28.
Dills WL: Sugar alcohols as bulk sweeteners. Annu Rev Nutr 1989;9:161–186.
29.
Elias E, Gibson GJ, Greenwood LF, Hunt JN, Tripp JH: The slowing of gastric emptying by monosaccharides and disaccharides in test meals. J Physiol Lond 1968;194:317–326.
30.
Kajs TM, Fitzgerald JA, Buckner RY, Coyle GA, Stinson BS, Morel JG: Influence of the methanogenic flora on the breath H2 and symptom response to ingestion of sorbitol or oat fiber. Am J Gastroenterol 1997;92:89–94.
31.
Salminen EK, Salminen SJ, Prokka L, Kwasowski P, Marks V, Koivstoinen PE: Xylitol vs. glucose: Effect in rate of gastric emptying and motilin, insulin and gastric inhibiting polypeptide release. Am J Clin Nutr 1989;49:1128–1132.
32.
Asano T, Levitt MD, Goetz FC: Xylitol absorption in healthy men. Diabetes 1973;22:279–281.
33.
Mäkinen KK, Ylikahri R, Mäkinen PL, Söderberg E, Hämälaissen M: Comparison of metabolic tolerance in human volunteers to high oral doses of xylitol and sucrose after long-term regular consumption of Xylitol. Experientia 1978(suppl 30):1.
34.
Jarreth M, Heitkemper MM, Bond EF, Georges J: Comparison of diet composition in women with and without functional bowel disorder. Gastroenterol Nurs 1994;16:253–258.
35.
Böhmer CJM, Tuynman HARE: The clinical relevance of lactose malabsorption in irritable bowel syndrome. Eur J Gastroenterol Hepatol 1996;8:1013–1016.
36.
Tolliver BA, Jackson MS, Jackson KL, Barnett ED, Chastang JF, DiPalma JA: Does lactose maldigestion really play a role in the irritable bowel syndrome? J Clin Gastroenterol 1996;23:15–17.
37.
Klauser AG, Voderholzer WA, Schindlbeck NE, Müller-Lissner SA: Functional diagnostic work-up in patients with irritable bowel syndrome. Z Gastroenterol 1996;34:273–278.
38.
Fernandez-Benatez F, Esteve-Pardo M, de Leon R, Humbert P, Carbé E, Llovet JM, Gassull MA: Sugar malabsorption in functional bowel disease: Clinical implications. Am J Gastroenterol 1993;88:2044–2050.
39.
Vernia P, Ricciardi MR, Frandina C, Bilotta T, Frieri G: Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet. Ital J Gastroenterol 1995;27:117–121.
40.
Newcomer AD, McGill DB: Irritable bowel syndrome. Role of lactase deficiency. Mayo Clin Proc 1983;58:339–341.
41.
Enck P, Kremer A, Kuhlbusch R, Niederau C, Erckenbrecht JF, Berges W: Prevalence of lactose malabsorption among patients with functional bowel disorders. Z Gastroenterol 1990;28:239–241.
42.
Schöfl R, Ferenci P, Vogelsang H, Gangl A: Einfluss einer laktosefreien Ernährung auf das Reizdarmsyndrom. Wien Klein Wochenschr 1993;105:342–345.
43.
Lasser RB, Bond JH, Levitt MD: The role of intestinal gas in functional abdominal pain. N Engl J Med 1975;293:524–526.
44.
Strocchi A, Levitt MD: Intestinal gas; in Sleisenger MH, Fordtran JS (eds): Gastrointestinal Disease. Philadelphia, Saunders, 1993, pp 1036–1042.
45.
Steggerda FR: Gastrointestinal gas following food consumption. Ann NY Acad Sci 1968;150:57–66.
46.
Sutalf LO, Levitt MD: Follow-up of a flatulent patient. Dig Dis Sci 1979;24:652–654.
47.
Levitt MD, Hirsh P, Fetzer CA, Sheahan M, Levine AS: H2 excretion after ingestion of complex carbohydrates. Gastroenterology 1987;92:383–389.
48.
Suarez F, Furner J, Springfield J, Levitt MD: Insights into human colonic physiology obtained from the study of flatus composition. Am J Physiol 1997;272:G1028–G1033.
49.
Nelis GF, Verneeren MAP, Jansen W: Role of fructose-sorbitol malabsorption in the irritable bowel syndrome. Gastroenterology 1990;99:1016–1020.
50.
Symons P, Jones MP, Kellow JE: Symptom provocation in irritable bowel syndrome. Effects of differing doses of fructose-sorbitol. Scand J Gastroenterol 1992;27:940–944.
51.
McKee AM, Prior A, Whorwell PJ: Exclusion diets in irritable bowel syndrome: Are they worthwhile? J Clin Gastroenterol 1987;9:526–528.
52.
King TS, Elia M, Hunter JO: Abnormal colonic fermentation in irritable bowel syndrome. Lancet 1998;352:1187–1189.
53.
Levitt MD, Furne J, Olsson S: The relation of passage of gas and abdominal bloating to colonic gas production. Ann Intern Med 1996;124:422–424.
54.
Serra J, Azpiroz F, Malagelada JR: Impaired transit and tolerance of intestinal gas in the irritable bowel syndrome. Gut 2001;48:14–19.
55.
Crowell MD, Cheskin LJ, Musial F: Prevalence of gastrointestinal symptoms in obese and normal weight binge eaters. Am J Gastroenterol 1994;89:387–391.
56.
Painter NS, Burkitt DP: Diverticular disease of the colon: A deficiency disease of Western civilization. BMJ 1971;ii:450–454.
57.
Painter NS: Irritable or irritated bowel? BMJ 1972;ii:46.
58.
Soltoft J, Gudmand-Hoyer E, Krag B, Kristensen E, Wulff HR: A double-blind trial of the effect of wheat bran on symptoms of irritable bowel syndrome. Lancet 1976;i:270–272.
59.
Manning AP, Heaton KW, Harvey RF, Uglow P: Wheat fibre and irritable bowel syndrome. Lancet 1977;ii:417–418.
60.
Cann PA, Read NW, Holdworth CD: What is the benefit of coarse wheat bran in patients with irritable bowel syndrome? Gut 1984;25:168–173.
61.
Arffmann S, Anderson JR, Hegnhoj et al: The effect of course wheat bran in the irritable bowel syndrome. Scand J Gastroenterol 1985;20:295–298.
62.
Lucey MR, Clark ML, Lowndes JO, Dawson AM: Is bran efficacious in irritable bowel syndrome? Gut 1987;28:221–225.
63.
Snook J, Shepherd HA: Bran supplementation in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 1994;8:511–514.
64.
Francis CY, Whorwell PJ: Bran and irritable bowel syndrome: Time for reappraisal. Lancet 1994;344:39–40.
65.
Heaton KW: Dietary fibre in perspective. Hum Nutr Clin Nutr 1983;37:151–170.
66.
Prior A, Whorwell PJ: Double-blind study of ispaghula in irritable bowel syndrome. Gut 1987;28:1510–1513.
67.
Kumar A, Kumar N, Vij JC, Sarin SK, Anand BS: Optimum dosage of ispaghula husk in patients with irritable bowel syndrome: Correlation of symptom relief with whole gut transit time and stool weight. Gut 1987;28:150–155.
68.
Ritchie JA, Truelove SC: Treatment of irritable bowel syndrome with lorazepam, hyoscine butylbromide, and ispaghula husk. Br Med J 1979;i:376–378.
69.
Longstreth GF, Fox DD, Youkeles L, Forsythe AB, Wolochow DA: Psyllium therapy in the irritable bowel syndrome. A double-blind trial. Ann Intern Med 1981;95:53–56.
70.
Golechha AC, Chadda VS, Chadda S, Sharma SK, Mishra SN: Role of ispaghula husk in the management of irritable bowel syndrome (a randomized double-blind crossover study). J Assoc Physicians India 1982;30:353–355.
71.
Soifer LO, De Paula JA, Caruso P: Effects of medicinal fiber on colonic transit in patients with irritable colon syndrome. Acta Gastroenterol Latinoam 1987;17:317–323.
72.
Jalihal A, Kurian G: Ispaghula therapy in irritable bowel syndrome: Improvement in overall well-being is related to reduction in bowel dissatisfaction. J Gastroenterol Hepatol 1990;5:507–513.
73.
Hotz J, Plein K: Effectiveness of plantago seed husks in comparison with wheat brain on stool frequency and manifestations of irritable colon syndrome with constipation. Med Klin 1994;89:645–651.
74.
Rees GA, Davies GI, Parker M, Trevor M: Gastrointestinal symptoms and diet of members of an irritable bowel self-help group J R Soc Health 1994;114:182–187.
75.
Freedman G: Diet and the irritable bowel syndrome. Gastroenterol Clin North Am 1991;20:313–324.
© 2003 S. Karger AG, Basel
2003
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.