Irritable bowel syndrome is a global problem that affects 7-15% of the population more often in women and people under the age of fifty (Altobelli, Negro, Angeletti, & Latella, 2017; Mckenzie et al., 2016). It is essentially a chronic gastrointestinal disorder characterized by abdominal pain or discomfort associated with impaired bowel function, while, there is no organic disease (Mckenzie et al., 2016). In addition to abdominal pain, there are bloating, constipation and / or diarrhea that all together affect the quality of life of patients and lead to increased rates of psychological stress (Altobelli et al., 2017).

In general, the physiopathology of this syndrome is not entirely clear, however, there are indications that the symptoms may be due to altered gastrointestinal motility in combination with visceral hypersensitivity, low-grade inflammation, altered microflora, and various food ingredients (Altob et al. 2017). In addition, psychological factors, disorders of the neuroendocrine system and heredity play a role.

Patients are categorized according to the differences that occur in the bowel movement

But how can this syndrome be diagnosed? Unfortunately, there is no biochemical, histopathological or radiological test, on the contrary, the diagnosis is made based on the evaluation of the symptoms. the Rome IV criteria formulated in 2016 (Kim & Jee, 2019) apply today. According to this diagnostic method the person should report recurrent abdominal pain at least once a week for the last three months, in combination with abnormalities during defecation in terms of change in the frequency or shape of the stool (Management, 2017). Factors such as age over fifty, very short-lived symptoms, weight loss, anemia, rectal bleeding and the presence of inflammation or infection should not be considered (El-Salhy, M., 2012).

There is a wide range of drug treatments that however target a single symptom usually the predominant one. However, in the presence of multiple symptoms, these treatments are insufficient (Altobelli et al., 2017; Camilleri, 2018). Currently the treatments concern lifestyle changes, dietary changes, alternative therapies with herbs, probiotics and specific drugs but also treatments based on psychology (Camilleri, 2018)

Some studies have looked at exercise as a way to improve symptoms. The findings of a specific study suggest that 20-60 minutes of moderate to vigorous exercise such as walking, cycling and aerobic exercise 3-5 times a week significantly improve both the symptoms of the syndrome and the psychological symptoms. Another study showed that yoga in particular as a method of exercise had positive results (Camilleri, 2018).

According to research, over 70% of patients associate the appearance or even worsening of symptoms with the consumption of specific foods (Altobelli et al., 2017). This can happen for four reasons. First, because of the reaction of the colon to the ingestion of certain foods. Secondly, due to changes in the natural microflora of the intestine which can be changed immediately after changes in diet. Third, insoluble fiber may make symptoms worse. Fourth and last, some dietary antigens may alter the intestinal epithelial barrier (Camilleri, 2018).

General dietary guidelines for Irritable Bowel Syndrome include eating frequent scheduled meals, reducing fiber, reducing caffeine, alcohol, fatty foods, avoiding lactose for certain patients only, avoiding foods such as whole grains and fructose. promote intestinal activation and finally, avoid foods that lead to increased gas production such as beans, and onions. Nevertheless, avoiding the consumption of dairy products, fatty foods, citrus fruits, wheat, caffeine and alcoholic beverages led to a negligible improvement in symptoms (Altobelli et al., 2017).

In recent years, the hypothesis that a diet reduced to low-grade fermentable oligosaccharides, disaccharides monosaccharides and polyols will significantly help people with irritable bowel syndrome – low FODMAP diet (Mckenzie et al., 2016). FODMAPs contain osmotically active short chain carbohydrates that are not fully absorbed and are rapidly fermented by gut bacteria. These may be, for example, fructose, lactose, fructans, galactans and polyols. Regarding the diet low in FODMAPs, many studies support the beneficial results and 70% of patients who followed it reported relief from some symptoms. On the contrary there are reports that long-term application of the diet over 18 months can lead to other problems such as deficiency in nutrients and mainly fiber. The implication is that FODMAP foods should be slowly reintegrated into the individual’s diet under the guidance of a specialist (Altobelli et al., 2017).

Bibliography

• Altobelli, E., Negro, V. Del, Angeletti, P. M., & Latella, G. (2017). Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms : A Meta-Analysis, 1–19. https://doi.org/10.3390/nu9090940
• Camilleri, M. (2018). Management Options for Irritable Bowel. Mayo Clinic Proceedings, 93(12), 1858–1872. https://doi.org/10.1016/j.mayocp.2018.04.032
• Kim, J. H., & Jee, S. R. (2019). Irritable Bowel Syndrome, 73(2), 84–91.
• Management, B. (2017). Cognitive-behavioral therapy for patients with irritable bowel syndrome : current insights, 231–237.
• Mckenzie, Y. A., Bowyer, R. K., Leach, H., Gulia, P., Horobin, J., Sullivan, N. A. O., … Guideline, I. B. S. D. (2016). British Dietetic Association systematic review and evidence- based practice guidelines for the dietary management of irritable bowel syndrome in adults ( 2016 update ), 549–575. https://doi.org/10.1111/jhn.12385
• El-Salhy, M. (2012). Irritable Bowel Syndrome : Diagnosis, Pathogenesis and Treatment Options. New York: Nova Science Publishers, Inc. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=nlebk&AN=605478&site=eds-live