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Mistakes in dietary management of IBS and how to avoid them

Jean W.M. Muris, Daniel Keszthelyi, Jenny Brouns, Zlatan Mujagic

Summary

AI Generated

People with IBS commonly identify food as a symptom trigger and often try dietary modifications independently, yet surveys show less than 10% value dietary intervention from their GP despite nearly all GPs starting treatment with nutritional advice.

  • More than 85% of people with IBS indicate that food is one of the triggers for their gastrointestinal symptoms.
  • Many people with IBS have tried diets, eliminated certain foods, taken supplements or used over-the-counter remedies before consulting a doctor or dietitian.
  • According to surveys of patients' expectations in primary care, patients with IBS expect their GP to provide reassurance or drug treatments, but less than 10% value dietary intervention.
  • Almost 95% of general practitioners report that they start the treatment of IBS by giving nutritional advice.
  • Dietary interventions are given a prominent place in guidelines as both first- and second-line treatments for IBS.
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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Van den Houte K, et al. Prevalence and impact of self-reported irritable bowel symptoms in the general population. United European Gastroenterol J 2019; 7: 307–315. [https://onlinelibrary.wiley.com/doi/10.1177/2050640618821804] [Link]
2.
Tornkvist NT, et al. Health care utilization of individuals with Rome IV irritable bowel syndrome in the general population. United European Gastroenterol J, 2021; 9: 1178–1188. [https://onlinelibrary.wiley.com/doi/10.1002/ueg2.12153] [Link]
3.
Bohn L, et al. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013; 108: 634–641. [Link]
4.
Sayuk GS, Wolf R and Chang L. Comparison of symptoms, healthcare utilization, and treatment in diagnosed and undiagnosed individuals with diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol 2017; 112: 892–899. [Link]
5.
Bijkerk CJ, et al. Irritable bowel syndrome in primary care: the patients' and doctors' views on symptoms, etiology and management. Can J Gastroenterol 2003; 17: 363–368. [Link]
6.
Lacy BE, et al. ACG Clinical Guideline: management of irritable bowel syndrome. Am J Gastroenterol 2021; 116: 17–44. [Link]
7.
Vasant DH, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021; 70: 1214–1240. [Link]
8.
McKenzie YA, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet 2016; 29: 549–575. [Link]
9.
Spiller R. Impact of diet on symptoms of the irritable bowel syndrome. Nutrients 2021; 13: 575. [Link]
10.
Moayyedi P, et al. Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice. United European Gastroenterol J 2017; 5: 773–788. [Link]
11.
Tigchelaar EF, et al. Habitual diet and diet quality in irritable bowel syndrome: a case-control study. Neurogastroenterol Motil 2017; 29: e13151. [Link]
12.
Onyimba F, et al. Food allergies and intolerances: a clinical approach to the diagnosis and management of adverse reactions to food. Clin Gastroenterol Hepatol 2021; 19: 2230–2240.e1. [Link]
13.
Lea R and Whorwell PJ. The role of food intolerance in irritable bowel syndrome. Gastroenterol Clin North Am 2005; 34: 247–255. [Link]
14.
Aguilera-Lizarraga J, et al. Local immune response to food antigens drives meal-induced abdominal pain. Nature 2021; 590: 151–156. [Link]
15.
Barbara G, et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 2007; 132: 26–37. [Link]
16.
Fabisiak A, et al. Targeting histamine receptors in irritable bowel syndrome: a critical appraisal. J Neurogastroenterol Motil 2017; 23: 341–348. [Link]
17.
Klooker TK, et al. The mast cell stabiliser ketotifen decreases visceral hypersensitivity and improves intestinal symptoms in patients with irritable bowel syndrome. Gut 2010; 59: 1213–1221. [Link]
18.
Essa H, et al. Hydrogen and methane breath test results are negatively associated with IBS and may reflect transit time in post-surgical patients. Neurogastroenterol Motil 2021; 33: e14033. [Link]
19.
Black, CJ and Ford AC. Rational investigations in irritable bowel syndrome. Frontline Gastroenterol 2020; 11: 140–147. [Link]
20.
Bonder MJ, et al. The effect of host genetics on the gut microbiome. Nat Genet 2016; 48: 1407–1412. [Link]
21.
So D, et al. Dietary fibres and IBS: translating functional characteristics to clinical value in the era of personalised medicine. Gut 2021; 70: 2383–2394. [Link]
22.
Gunn D, et al. Psyllium reduces inulin-induced colonic gas production in IBS: MRI and in vitro fermentation studies. Gut Epub ahead of print 5 August 2021. DOI: 10.1136/gutjnl-2021-324784. [Link]
23.
Moayyedi P, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 1367–1374. [Link]
24.
Wilson B, et al. Prebiotics in irritable bowel syndrome and other functional bowel disorders in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2019; 109: 1098–1111. [Link]
25.
Dionne J, et al. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol 2018; 113: 1290 –1300. [Link]
26.
Barone M, et al. Evaluation of non-celiac gluten sensitivity in patients with previous diagnosis of irritable bowel syndrome: a randomized double-blind placebo-controlled crossover trial. Nutrients 2020; 12: 705. [Link]
27.
Skodje GI, et al. Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity. Gastroenterology 2018; 154: 529–539.e2. [Link]
28.
Cuccioloni M, et al. Interfering with the high-affinity interaction between wheat amylase trypsin inhibitor CM3 and toll-like receptor 4: in silico and biosensor-based studies. Sci Rep 2017; 7: 13169. [Link]
29.
Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2021; Aug 10; gutjnl-2021-325214. [Link]
30.
Böhn L, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology 2015; 149: 1399–1407.e2. [Link]
31.
Vandeputte D and Joossens M. Effects of low and high FODMAP diets on human gastrointestinal microbiota composition in adults with intestinal diseases: a systematic review. Microorganisms 2020; 8: 1638. [Link]
32.
Wang XJ, et al. Review article: biological mechanisms for symptom causation by individual FODMAP subgroups — the case for a more personalised approach to dietary restriction. Aliment Pharmacol Ther 2019; 50: 517–529. [Link]
33.
Bennet SMP, et al. Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. Gut 2018; 67: 872–881. [Link]
34.
Zamani M, Alizadeh-Tabari S and Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2019; 50: 132–143. [Link]
35.
Simons M, et al. Narrative review: Risk of eating disorders and nutritional deficiencies with dietary therapies for irritable bowel syndrome. Neurogastroenterol Motil 2021; 34: e14188. [Link]

Abstract

People with irritable bowel syndrome (IBS) experience chronic intermittent symptoms, such as abdominal pain, bloating and/or altered bowel movements. These symptoms may negatively impact their daily life, prohibiting participation in social activities or leading to work absenteeism, and they are associated with increased healthcare utilisation.More than 85% of people with IBS indicate that food is one of the triggers for their gastrointestinal symptoms. Many of them have also tried diets, eliminated certain foods, taken supplements or used over-the-counter remedies before consulting a doctor or dietitian.4 Somewhat contradictorily, according to surveys of patients’ expectations in primary care, patients with IBS expect their general practitioner to provide reassurance or drug treatments, but less than 10% value dietary intervention. This is despite the fact that almost 95% of general practitioners report that they start the treatment of IBS by giving nutritional advice.5 Dietary interventions are also given a prominent place in the guidelines as both first- and second-line treatments for IBS.


Topics

Neurogastroenterology & Motility

Citation

Mujagic Z, Brouns J, Keszthelyi D and Muris JWM. Mistakes in dietary management of IBS and how to avoid them. UEG Education 2022; 22: 1–4.

Published

2022

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Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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Mistakes in Familial Mediterranean Fever and how to avoid them

Manik Gemilyan, Gagik Hakobyan

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Van den Houte K, et al. Prevalence and impact of self-reported irritable bowel symptoms in the general population. United European Gastroenterol J 2019; 7: 307–315. [https://onlinelibrary.wiley.com/doi/10.1177/2050640618821804] [Link]
2.
Tornkvist NT, et al. Health care utilization of individuals with Rome IV irritable bowel syndrome in the general population. United European Gastroenterol J, 2021; 9: 1178–1188. [https://onlinelibrary.wiley.com/doi/10.1002/ueg2.12153] [Link]
3.
Bohn L, et al. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013; 108: 634–641. [Link]
4.
Sayuk GS, Wolf R and Chang L. Comparison of symptoms, healthcare utilization, and treatment in diagnosed and undiagnosed individuals with diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol 2017; 112: 892–899. [Link]
5.
Bijkerk CJ, et al. Irritable bowel syndrome in primary care: the patients' and doctors' views on symptoms, etiology and management. Can J Gastroenterol 2003; 17: 363–368. [Link]
6.
Lacy BE, et al. ACG Clinical Guideline: management of irritable bowel syndrome. Am J Gastroenterol 2021; 116: 17–44. [Link]
7.
Vasant DH, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021; 70: 1214–1240. [Link]
8.
McKenzie YA, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet 2016; 29: 549–575. [Link]
9.
Spiller R. Impact of diet on symptoms of the irritable bowel syndrome. Nutrients 2021; 13: 575. [Link]
10.
Moayyedi P, et al. Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice. United European Gastroenterol J 2017; 5: 773–788. [Link]
11.
Tigchelaar EF, et al. Habitual diet and diet quality in irritable bowel syndrome: a case-control study. Neurogastroenterol Motil 2017; 29: e13151. [Link]
12.
Onyimba F, et al. Food allergies and intolerances: a clinical approach to the diagnosis and management of adverse reactions to food. Clin Gastroenterol Hepatol 2021; 19: 2230–2240.e1. [Link]
13.
Lea R and Whorwell PJ. The role of food intolerance in irritable bowel syndrome. Gastroenterol Clin North Am 2005; 34: 247–255. [Link]
14.
Aguilera-Lizarraga J, et al. Local immune response to food antigens drives meal-induced abdominal pain. Nature 2021; 590: 151–156. [Link]
15.
Barbara G, et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 2007; 132: 26–37. [Link]
16.
Fabisiak A, et al. Targeting histamine receptors in irritable bowel syndrome: a critical appraisal. J Neurogastroenterol Motil 2017; 23: 341–348. [Link]
17.
Klooker TK, et al. The mast cell stabiliser ketotifen decreases visceral hypersensitivity and improves intestinal symptoms in patients with irritable bowel syndrome. Gut 2010; 59: 1213–1221. [Link]
18.
Essa H, et al. Hydrogen and methane breath test results are negatively associated with IBS and may reflect transit time in post-surgical patients. Neurogastroenterol Motil 2021; 33: e14033. [Link]
19.
Black, CJ and Ford AC. Rational investigations in irritable bowel syndrome. Frontline Gastroenterol 2020; 11: 140–147. [Link]
20.
Bonder MJ, et al. The effect of host genetics on the gut microbiome. Nat Genet 2016; 48: 1407–1412. [Link]
21.
So D, et al. Dietary fibres and IBS: translating functional characteristics to clinical value in the era of personalised medicine. Gut 2021; 70: 2383–2394. [Link]
22.
Gunn D, et al. Psyllium reduces inulin-induced colonic gas production in IBS: MRI and in vitro fermentation studies. Gut Epub ahead of print 5 August 2021. DOI: 10.1136/gutjnl-2021-324784. [Link]
23.
Moayyedi P, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 1367–1374. [Link]
24.
Wilson B, et al. Prebiotics in irritable bowel syndrome and other functional bowel disorders in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2019; 109: 1098–1111. [Link]
25.
Dionne J, et al. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol 2018; 113: 1290 –1300. [Link]
26.
Barone M, et al. Evaluation of non-celiac gluten sensitivity in patients with previous diagnosis of irritable bowel syndrome: a randomized double-blind placebo-controlled crossover trial. Nutrients 2020; 12: 705. [Link]
27.
Skodje GI, et al. Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity. Gastroenterology 2018; 154: 529–539.e2. [Link]
28.
Cuccioloni M, et al. Interfering with the high-affinity interaction between wheat amylase trypsin inhibitor CM3 and toll-like receptor 4: in silico and biosensor-based studies. Sci Rep 2017; 7: 13169. [Link]
29.
Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2021; Aug 10; gutjnl-2021-325214. [Link]
30.
Böhn L, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology 2015; 149: 1399–1407.e2. [Link]
31.
Vandeputte D and Joossens M. Effects of low and high FODMAP diets on human gastrointestinal microbiota composition in adults with intestinal diseases: a systematic review. Microorganisms 2020; 8: 1638. [Link]
32.
Wang XJ, et al. Review article: biological mechanisms for symptom causation by individual FODMAP subgroups — the case for a more personalised approach to dietary restriction. Aliment Pharmacol Ther 2019; 50: 517–529. [Link]
33.
Bennet SMP, et al. Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. Gut 2018; 67: 872–881. [Link]
34.
Zamani M, Alizadeh-Tabari S and Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2019; 50: 132–143. [Link]
35.
Simons M, et al. Narrative review: Risk of eating disorders and nutritional deficiencies with dietary therapies for irritable bowel syndrome. Neurogastroenterol Motil 2021; 34: e14188. [Link]

Abstract

Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.1 Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.2 Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.3

Topics

Primary Care

Published

2025

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UEG Podcast
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Management of gastric preneoplastic lesions (MAPS 3) - what’s new? With Mario Dinis-Ribeiro (Part 2)

Mario Dinis-Ribeiro, Pradeep Mundre

Summary

AI Generated

Summary is not available for this content yet.

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Stomach & H. Pylori

Published

2025

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UEG Standards and Guidelines
Consensus
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European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Guideline

ABSTRACT

Introduction

Chronic nausea and vomiting are symptoms of a wide range of gastrointestinal and non-gastrointestinal conditions. Diagnosis can be challenging and requires a systematic and well-structured approach. If the initial investigation for structural, toxic and metabolic disorders is negative, digestive motility and gut-brain interaction disorders should be assessed. United European Gastroenterology (UEG) and the European Society for Neurogastroenterology and Motility (ESNM) identified the need for an updated, evidence-based clinical guideline for the management of chronic nausea and vomiting.

Methods

A multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of the guideline. Relevant questions were addressed through a literature review and statements were developed and voted on according to a Delphi process.

Results

Ninety-eight statements were identified and voted following the Delphi process. Overall agreement was high, although the grade of scientific evidence was low in many areas. Disagreement was more evident for some pharmacological treatment options. A diagnostic algorithm was developed, focussing on the differentiating features between gastrointestinal motility and gut-brain interaction disorders with predominant nausea and vomiting.

Conclusion

These guidelines provide an evidence-based framework for the evaluation and treatment of patients with chronic nausea and vomiting.

Publisher

European Society of Neurogastroenterology and Motility logo
European Society of Neurogastroenterology and Motility

Guideline

Consensus

Topics

Neurogastroenterology & Motility Paediatrics Primary Care Stomach & H. Pylori

Citation

United European Gastroenterol J.

Published

2025

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Mistakes in the management of carbohydrate intolerance and how to avoid them

Johann Hammer, Heinz Florian Hammer, Mark Fox

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Van den Houte K, et al. Prevalence and impact of self-reported irritable bowel symptoms in the general population. United European Gastroenterol J 2019; 7: 307–315. [https://onlinelibrary.wiley.com/doi/10.1177/2050640618821804] [Link]
2.
Tornkvist NT, et al. Health care utilization of individuals with Rome IV irritable bowel syndrome in the general population. United European Gastroenterol J, 2021; 9: 1178–1188. [https://onlinelibrary.wiley.com/doi/10.1002/ueg2.12153] [Link]
3.
Bohn L, et al. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013; 108: 634–641. [Link]
4.
Sayuk GS, Wolf R and Chang L. Comparison of symptoms, healthcare utilization, and treatment in diagnosed and undiagnosed individuals with diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol 2017; 112: 892–899. [Link]
5.
Bijkerk CJ, et al. Irritable bowel syndrome in primary care: the patients' and doctors' views on symptoms, etiology and management. Can J Gastroenterol 2003; 17: 363–368. [Link]
6.
Lacy BE, et al. ACG Clinical Guideline: management of irritable bowel syndrome. Am J Gastroenterol 2021; 116: 17–44. [Link]
7.
Vasant DH, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021; 70: 1214–1240. [Link]
8.
McKenzie YA, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet 2016; 29: 549–575. [Link]
9.
Spiller R. Impact of diet on symptoms of the irritable bowel syndrome. Nutrients 2021; 13: 575. [Link]
10.
Moayyedi P, et al. Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice. United European Gastroenterol J 2017; 5: 773–788. [Link]
11.
Tigchelaar EF, et al. Habitual diet and diet quality in irritable bowel syndrome: a case-control study. Neurogastroenterol Motil 2017; 29: e13151. [Link]
12.
Onyimba F, et al. Food allergies and intolerances: a clinical approach to the diagnosis and management of adverse reactions to food. Clin Gastroenterol Hepatol 2021; 19: 2230–2240.e1. [Link]
13.
Lea R and Whorwell PJ. The role of food intolerance in irritable bowel syndrome. Gastroenterol Clin North Am 2005; 34: 247–255. [Link]
14.
Aguilera-Lizarraga J, et al. Local immune response to food antigens drives meal-induced abdominal pain. Nature 2021; 590: 151–156. [Link]
15.
Barbara G, et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 2007; 132: 26–37. [Link]
16.
Fabisiak A, et al. Targeting histamine receptors in irritable bowel syndrome: a critical appraisal. J Neurogastroenterol Motil 2017; 23: 341–348. [Link]
17.
Klooker TK, et al. The mast cell stabiliser ketotifen decreases visceral hypersensitivity and improves intestinal symptoms in patients with irritable bowel syndrome. Gut 2010; 59: 1213–1221. [Link]
18.
Essa H, et al. Hydrogen and methane breath test results are negatively associated with IBS and may reflect transit time in post-surgical patients. Neurogastroenterol Motil 2021; 33: e14033. [Link]
19.
Black, CJ and Ford AC. Rational investigations in irritable bowel syndrome. Frontline Gastroenterol 2020; 11: 140–147. [Link]
20.
Bonder MJ, et al. The effect of host genetics on the gut microbiome. Nat Genet 2016; 48: 1407–1412. [Link]
21.
So D, et al. Dietary fibres and IBS: translating functional characteristics to clinical value in the era of personalised medicine. Gut 2021; 70: 2383–2394. [Link]
22.
Gunn D, et al. Psyllium reduces inulin-induced colonic gas production in IBS: MRI and in vitro fermentation studies. Gut Epub ahead of print 5 August 2021. DOI: 10.1136/gutjnl-2021-324784. [Link]
23.
Moayyedi P, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 1367–1374. [Link]
24.
Wilson B, et al. Prebiotics in irritable bowel syndrome and other functional bowel disorders in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2019; 109: 1098–1111. [Link]
25.
Dionne J, et al. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol 2018; 113: 1290 –1300. [Link]
26.
Barone M, et al. Evaluation of non-celiac gluten sensitivity in patients with previous diagnosis of irritable bowel syndrome: a randomized double-blind placebo-controlled crossover trial. Nutrients 2020; 12: 705. [Link]
27.
Skodje GI, et al. Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity. Gastroenterology 2018; 154: 529–539.e2. [Link]
28.
Cuccioloni M, et al. Interfering with the high-affinity interaction between wheat amylase trypsin inhibitor CM3 and toll-like receptor 4: in silico and biosensor-based studies. Sci Rep 2017; 7: 13169. [Link]
29.
Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2021; Aug 10; gutjnl-2021-325214. [Link]
30.
Böhn L, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology 2015; 149: 1399–1407.e2. [Link]
31.
Vandeputte D and Joossens M. Effects of low and high FODMAP diets on human gastrointestinal microbiota composition in adults with intestinal diseases: a systematic review. Microorganisms 2020; 8: 1638. [Link]
32.
Wang XJ, et al. Review article: biological mechanisms for symptom causation by individual FODMAP subgroups — the case for a more personalised approach to dietary restriction. Aliment Pharmacol Ther 2019; 50: 517–529. [Link]
33.
Bennet SMP, et al. Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. Gut 2018; 67: 872–881. [Link]
34.
Zamani M, Alizadeh-Tabari S and Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2019; 50: 132–143. [Link]
35.
Simons M, et al. Narrative review: Risk of eating disorders and nutritional deficiencies with dietary therapies for irritable bowel syndrome. Neurogastroenterol Motil 2021; 34: e14188. [Link]

Abstract

Carbohydrates not absorbed in the small intestine are fermented by colonic bacteria to organic acids and gases(e.g. carbon dioxide, hydrogen and methane), part of which is absorbed in the colon, the other part remaining in the lumen. Large interindividual differences have been demonstrated for the production of such acids and gas. Carbohydrate malabsorption can be diagnosed by using the hydrogen breath test, because the gases produced after administration of a provocative dose of carbohydrate are unique products of bacterial carbohydrate fermentation.

Topics

Small Intestine & Nutrition

Citation

Hammer HF, Hammer J and Fox M. Mistakes in the management of carbohydrate intolerance and how to avoid them. UEG Education 2019; 19: 9–14

Published

2019

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UEG Standards and Guidelines
Consensus
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European Consensus on Functional Bloating and Abdominal Distension—An ESNM/UEG Recommendations for Clinical Management

Chloé Melchior

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Guideline

ABSTRACT

Introduction

Abdominal distension is an objective visible sign of increased abdominal girth. Bloating is a feeling of abdominal fullness and discomfort. Bloating may be associated or not with abdominal distension. Bloating and abdominal distension are among the most commonly reported gastrointestinal symptoms and may be associated with both organic and functional disorders. Nevertheless, specific consensus and recommendations on diagnosis, underlying mechanisms, assessment and management of functional bloating and abdominal distension are still lacking. The aim of this European consensus, then, is to provide expert opinions and recommendations on the epidemiology, diagnosis, pathophysiology and treatment of functional bloating and abdominal distension.

Methods

A multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of this consensus. Relevant questions were formulated and addressed through a literature review and statements were developed and voted using a Delphi process.

Results

Functional bloating and abdominal distension are common and frequently overlap with other disorders of gut-brain interaction. Diagnosis is made according to the Rome IV criteria after the exclusion of organic disease, based on the physical examination and assessment of the patient's medical history and alarming signs. In the absence of alarming signs or any relevant finding, clinical laboratory, imaging or endoscopic tests are unnecessary. The pathophysiology of functional bloating and abdominal distension is multifactorial and involves visceral hypersensitivity, abdomino-phrenic dyssynergia, intestinal dysmotility and dysbiosis. Treatment may include dietary modifications (e.g. lactose-limiting diet and low FODMAP diet), probiotics, antispasmodics (e.g., otilonium bromide, peppermint oil), rifaximin, secretagogues (e.g., linaclotide), neuromodulators (e.g., serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, buspirone), and plethysmography-based biofeedback. Moreover, cognitive behaviour therapy and hypnotherapy can be used in case of functional bloating associated with irritable bowel syndrome.

Conclusion

This consensus provides an evidence-based framework for the evaluation and treatment of patients with functional bloating and abdominal distension.

Publisher

European Society of Neurogastroenterology and Motility logo
European Society of Neurogastroenterology and Motility

Guideline

Consensus

Topics

Neurogastroenterology & Motility

Citation

United European Gastroenterology Journal, 2025; 13:1613–1651

Published

2025

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UEG Mistakes In Articles
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Mistakes in metabolic dysfunction associated steatotic liver disease and how to avoid them

Sarah Townsend, Philip Newsome

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Van den Houte K, et al. Prevalence and impact of self-reported irritable bowel symptoms in the general population. United European Gastroenterol J 2019; 7: 307–315. [https://onlinelibrary.wiley.com/doi/10.1177/2050640618821804] [Link]
2.
Tornkvist NT, et al. Health care utilization of individuals with Rome IV irritable bowel syndrome in the general population. United European Gastroenterol J, 2021; 9: 1178–1188. [https://onlinelibrary.wiley.com/doi/10.1002/ueg2.12153] [Link]
3.
Bohn L, et al. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013; 108: 634–641. [Link]
4.
Sayuk GS, Wolf R and Chang L. Comparison of symptoms, healthcare utilization, and treatment in diagnosed and undiagnosed individuals with diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol 2017; 112: 892–899. [Link]
5.
Bijkerk CJ, et al. Irritable bowel syndrome in primary care: the patients' and doctors' views on symptoms, etiology and management. Can J Gastroenterol 2003; 17: 363–368. [Link]
6.
Lacy BE, et al. ACG Clinical Guideline: management of irritable bowel syndrome. Am J Gastroenterol 2021; 116: 17–44. [Link]
7.
Vasant DH, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut 2021; 70: 1214–1240. [Link]
8.
McKenzie YA, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet 2016; 29: 549–575. [Link]
9.
Spiller R. Impact of diet on symptoms of the irritable bowel syndrome. Nutrients 2021; 13: 575. [Link]
10.
Moayyedi P, et al. Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice. United European Gastroenterol J 2017; 5: 773–788. [Link]
11.
Tigchelaar EF, et al. Habitual diet and diet quality in irritable bowel syndrome: a case-control study. Neurogastroenterol Motil 2017; 29: e13151. [Link]
12.
Onyimba F, et al. Food allergies and intolerances: a clinical approach to the diagnosis and management of adverse reactions to food. Clin Gastroenterol Hepatol 2021; 19: 2230–2240.e1. [Link]
13.
Lea R and Whorwell PJ. The role of food intolerance in irritable bowel syndrome. Gastroenterol Clin North Am 2005; 34: 247–255. [Link]
14.
Aguilera-Lizarraga J, et al. Local immune response to food antigens drives meal-induced abdominal pain. Nature 2021; 590: 151–156. [Link]
15.
Barbara G, et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 2007; 132: 26–37. [Link]
16.
Fabisiak A, et al. Targeting histamine receptors in irritable bowel syndrome: a critical appraisal. J Neurogastroenterol Motil 2017; 23: 341–348. [Link]
17.
Klooker TK, et al. The mast cell stabiliser ketotifen decreases visceral hypersensitivity and improves intestinal symptoms in patients with irritable bowel syndrome. Gut 2010; 59: 1213–1221. [Link]
18.
Essa H, et al. Hydrogen and methane breath test results are negatively associated with IBS and may reflect transit time in post-surgical patients. Neurogastroenterol Motil 2021; 33: e14033. [Link]
19.
Black, CJ and Ford AC. Rational investigations in irritable bowel syndrome. Frontline Gastroenterol 2020; 11: 140–147. [Link]
20.
Bonder MJ, et al. The effect of host genetics on the gut microbiome. Nat Genet 2016; 48: 1407–1412. [Link]
21.
So D, et al. Dietary fibres and IBS: translating functional characteristics to clinical value in the era of personalised medicine. Gut 2021; 70: 2383–2394. [Link]
22.
Gunn D, et al. Psyllium reduces inulin-induced colonic gas production in IBS: MRI and in vitro fermentation studies. Gut Epub ahead of print 5 August 2021. DOI: 10.1136/gutjnl-2021-324784. [Link]
23.
Moayyedi P, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 1367–1374. [Link]
24.
Wilson B, et al. Prebiotics in irritable bowel syndrome and other functional bowel disorders in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2019; 109: 1098–1111. [Link]
25.
Dionne J, et al. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol 2018; 113: 1290 –1300. [Link]
26.
Barone M, et al. Evaluation of non-celiac gluten sensitivity in patients with previous diagnosis of irritable bowel syndrome: a randomized double-blind placebo-controlled crossover trial. Nutrients 2020; 12: 705. [Link]
27.
Skodje GI, et al. Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity. Gastroenterology 2018; 154: 529–539.e2. [Link]
28.
Cuccioloni M, et al. Interfering with the high-affinity interaction between wheat amylase trypsin inhibitor CM3 and toll-like receptor 4: in silico and biosensor-based studies. Sci Rep 2017; 7: 13169. [Link]
29.
Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2021; Aug 10; gutjnl-2021-325214. [Link]
30.
Böhn L, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology 2015; 149: 1399–1407.e2. [Link]
31.
Vandeputte D and Joossens M. Effects of low and high FODMAP diets on human gastrointestinal microbiota composition in adults with intestinal diseases: a systematic review. Microorganisms 2020; 8: 1638. [Link]
32.
Wang XJ, et al. Review article: biological mechanisms for symptom causation by individual FODMAP subgroups — the case for a more personalised approach to dietary restriction. Aliment Pharmacol Ther 2019; 50: 517–529. [Link]
33.
Bennet SMP, et al. Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. Gut 2018; 67: 872–881. [Link]
34.
Zamani M, Alizadeh-Tabari S and Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2019; 50: 132–143. [Link]
35.
Simons M, et al. Narrative review: Risk of eating disorders and nutritional deficiencies with dietary therapies for irritable bowel syndrome. Neurogastroenterol Motil 2021; 34: e14188. [Link]

Abstract

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a subclassification of steatotic liver disease (SLD), defined as the presence of excess triglyceride storage in the liver in conjunction with at least one cardiometabolic risk factor and no other discernible cause.1 Cirrhosis secondary to MASH is the most common cause of liver disease in the world and is the fastest-growing indication for liver transplantation, but it also has a >50% recurrence rate post-transplantation.

Topics

Hepatobiliary

Citation

Townsend SA and Newsome PN. Mistakes in nonalcoholic fatty liver disease and how to avoid them. UEG Education 2017; 17: 39–41.

Published

2024

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Mistakes in metabolic dysfunction associated steatotic liver disease and how to avoid them

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