Review article: exclude or expose? The paradox of conceptually opposite treatments for irritable bowel syndrome.
Aliment Pharmacol Ther
; 56(4): 592-605, 2022 08.
Article
em En
| MEDLINE
| ID: mdl-35775328
ABSTRACT
BACKGROUND:
Irritable bowel syndrome (IBS) is a heterogeneous disorder of gut-brain interaction (DGBI) maintained by interacting biological, psychological, and social processes. Interestingly, there are two contrasting yet evidence-based treatment approaches for reducing IBS symptoms exclusion diets such as those low in fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) and exposure-based cognitive-behavioural therapy (CBT). Exclusion diets recommend patients avoid foods thought to be symptom-inducing, whereas exposure-based CBT encourages patients to expose themselves to foods.AIMS:
To address the paradox of conceptually opposite exclusion diets and exposure-based CBT for IBS.METHODS:
In this conceptual review, we describe the rationale, practical implementation, evidence base and strengths and weaknesses of each treatment. We conducted up-to-date literature search concerning the low FODMAP diet and CBT, and performed a secondary analysis of a previously conducted trial to illustrate a key point in our review.RESULTS:
The low FODMAP diet has demonstrated efficacy, but problems with adherence, nutritional compromise, and heightened gastrointestinal-specific anxiety raise caution. Exposure-based CBT has demonstrated efficacy with substantial evidence for gastrointestinal-specific anxiety as a key mechanism of action. Mediation analysis also showed that increased FODMAP intake mediated decreased symptom severity in exposure-based CBT. However, there is minimal evidence supporting which treatment "works best for whom" and how these approaches could be best integrated.CONCLUSIONS:
Even though exclusion diets and exposure-based CBT are conceptually opposite, they each have proven efficacy. Clinicians should familiarise themselves with both treatments. Further research is needed on predictors, mechanisms and moderators of treatment outcomes.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Terapia Cognitivo-Comportamental
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Síndrome do Intestino Irritável
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Dieta com Restrição de Carboidratos
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article