Are adverse food reactions linked to irritable bowel... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

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Niec, Anna M BSc, M Nutr Diet1; Frankum, Brad B Med (Hons), FRACP1; Talley, Nicholas J MD, PhD, FRACP, FACG1,*

1Department of Medicine, University of Sydney, Nepean Hospital, Penrith, Australia

*Professor of Medicine, Department of Medicine, University of Sydney, Nepean Hospital, Penrith, 2751, N.S.W., Australia

Abstract

Objective:

We undertook to determine whether adverse food reactions play a role in irritable bowel syndrome (IBS).

Methods:

A systematic review of the literature using Medline (1980–1996), targeting IBS and adverse food reactions, was performed. All clinical trials whereby dietary exclusion was followed by food challenge were selected. Each study was reviewed using a structured format to examine methodological issues and study outcomes.

Results:

Of the seven studies included, the positive response to an elimination diet ranged from 15% to 71%; double-blind placebo-controlled challenges identified problem foods in 6% to 58% of cases. Milk, wheat, and eggs were most frequently identified to cause symptom exacerbation; of the foods identified the most common trait was a high salicylate content. Foods high in amines were also identified. Studies of diarrhea-predominant IBS identified a higher percentage of adverse food reactions. However, all studies had major limitations in their trial designs, including inadequate patient selection, appropriateness of—and duration of—exclusion diets, and methods of food challenge.

Conclusion:

Whether adverse reactions to foods are a key factor in exacerbating IBS symptoms or whether dietary manipulation is a valid treatment option is unclear. Carefully designed controlled clinical trials are now needed to specifically test the potential role of adverse food reactions in diarrhea-predominant IBS.