The Effect of Dietary Intervention on Irritable Bowel Syndrome: A Systematic Review.
OBJECTIVE
Elimination diets have been used for many years to treat irritable bowel syndrome (IBS). These approaches had fallen out of favor until a recent resurgence, which was based on new randomized controlled trial (RCT) data that suggested it might be effective. The evidence for the efficacy of dietary therapies has not been evaluated systematically. We have therefore conducted a systematic review to examine this issue.


METHODS
MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched up to December 2013. Trials recruiting adults with IBS, which compared any form of dietary restriction or addition of an offending food group in patients already on a restricted diet vs. placebo, control therapy, or "usual management", were eligible. Dichotomous symptom data were pooled to obtain a relative risk of remaining symptomatic after therapy as well as the number needed to treat with a 95% confidence interval.


RESULTS
We identified 17 RCTs involving 1,568 IBS patients that assessed elimination diets. Only three RCTs involving 230 patients met our eligibility criteria, all of which evaluated different approaches, and thus a meta-analysis could not be conducted.


CONCLUSIONS
More evidence is needed before generally recommending elimination diets for IBS patients.
Farncombe Family Digestive Health Research Institute, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada.
Paul
P
Moayyedi
Division of Gastroenterology and Hepatology, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA.
Eamonn M M
EM
Quigley
Dartmouth-Hitchcock Medical Centre, Division of Gastroenterology and Hepatology, One Medical Centre Drive, Lebanon, New Hampshire, USA.
Brian E
BE
Lacy
The Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA.
Anthony J
AJ
Lembo
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Yuri A
YA
Saito
Digestive Health Associates of Texas, Baylor University Medical Centre, Dallas, Texas, USA.
Lawrence R
LR
Schiller
Division of Gastroenterology at Cedars-Sinai, University of Southern California, Los Angeles, California, USA.
Edy E
EE
Soffer
Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Brennan M R
BM
Spiegel
Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.|Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
Alexander C
AC
Ford