Intest Res.  2023 Apr;21(2):189-195. 10.5217/ir.2021.00136.

An Asian perspective on irritable bowel syndrome

• Jung KW
• Myung SJ

• KMID: 2541891
• DOI: http://doi.org/10.5217/ir.2021.00136

Abstract

Irritable bowel syndrome (IBS) is a prevalent chronic disorder, and its epidemiology depends on the diagnostic criteria used. Recently, the Rome IV criteria for IBS were published by changing the frequency of abdominal pain and excluding abdominal discomfort from the previously used Rome III criteria. However, the recent Asian consensus on IBS recommends the inclusion of abdominal discomfort and abdominal pain as diagnostic criteria. The low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP) diet has been proven to be effective in Western patients. Moreover, recent well-designed studies reported its effectiveness and the microbial changes after implementing it in Asian patients with IBS. However, traditional Korean foods including kimchi, one of representative FODMAP-rich food, exhibited a poor correlation with the food-related symptoms of IBS. Therefore, the low FODMAP diet protocol should be cautiously applied to IBS patients, especially to Korean patients with IBS. In Asian countries, there are lots of traditional herbal medicines and treatments for IBS; however, these studies have limitations including the heterogeneity of herbal mixtures and relatively small sample size. Therefore, well-designed studies based on large samples are required to validate complementary and alternative medicine in the treatment of Asian patients with IBS.

Keyword

Irritable bowel syndrome; Diagnosis; Therapy

Reference

1. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation Global Study. Gastroenterology. 2021; 160:99–114.

2. Sperber AD, Dumitrascu D, Fukudo S, et al. The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review. Gut. 2017; 66:1075–1082.

3. Bouchoucha M, Devroede G, Girault-Lidvan N, Hejnar M, Mary F, Benamouzig R. Psychological profiles of irritable bowel syndrome patients with different phenotypes. Intest Res. 2020; 18:459–468.

4. Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021; 116:17–44.

5. Mitselou A, Grammeniatis V, Varouktsi A, Papadatos SS, Katsanos K, Galani V. Proinflammatory cytokines in irritable bowel syndrome: a comparison with inflammatory bowel disease. Intest Res. 2020; 18:115–120.

6. Shafiee NH, Razalli NH, Mokhtar NM, Tan E, Ali R. An evaluation of dietary adequacy among patients with constipation-predominant irritable bowel syndrome in Malaysia. Intest Res. 2022; 20:124–133.

7. Gibson PR, Halmos EP, Muir JG. Review article: FODMAPS, prebiotics and gut health-the FODMAP hypothesis revisited. Aliment Pharmacol Ther. 2020; 52:233–246.

8. Liu J, Chey WD, Haller E, Eswaran S. Low-FODMAP diet for irritable bowel syndrome: what we know and what we have yet to learn. Annu Rev Med. 2020; 71:303–314.

9. Iacovou M, Tan V, Muir JG, Gibson PR. The low FODMAP diet and its application in East and Southeast Asia. J Neurogastroenterol Motil. 2015; 21:459–470.

10. Gwee KA, Ghoshal UC, Chen M. Irritable bowel syndrome in Asia: pathogenesis, natural history, epidemiology, and management. J Gastroenterol Hepatol. 2018; 33:99–110.

11. Han SH, Lee OY, Bae SC, et al. Prevalence of irritable bowel syndrome in Korea: population-based survey using the Rome II criteria. J Gastroenterol Hepatol. 2006; 21:1687–1692.

12. Park DW, Lee OY, Shim SG, et al. The differences in prevalence and sociodemographic characteristics of irritable bowel syndrome according to Rome II and Rome III. J Neurogastroenterol Motil. 2010; 16:186–193.

13. Sperber AD. Epidemiology and burden of irritable bowel syndrome: an international perspective. Gastroenterol Clin North Am. 2021; 50:489–503.

14. Mearin F, Lacy BE, Chang L, et al. Bowel disorders. Gastroenterology. 2016; 150:1393–1407.

15. Chuah KH, Mahadeva S. Cultural factors influencing functional gastrointestinal disorders in the East. J Neurogastroenterol Motil. 2018; 24:536–543.

16. Gwee KA, Gonlachanvit S, Ghoshal UC, et al. Second Asian consensus on irritable bowel syndrome. J Neurogastroenterol Motil. 2019; 25:343–362.

17. Gwee KA, Wee S, Wong ML, Png DJ. The prevalence, symptom characteristics, and impact of irritable bowel syndrome in an Asian urban community. Am J Gastroenterol. 2004; 99:924–931.

18. Kwan AC, Hu WH, Chan YK, Yeung YW, Lai TS, Yuen H. Prevalence of irritable bowel syndrome in Hong Kong. J Gastroenterol Hepatol. 2002; 17:1180–1186.

19. Ringel Y, Williams RE, Kalilani L, Cook SF. Prevalence, characteristics, and impact of bloating symptoms in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2009; 7:68–72.

20. Gerson CD, Gerson MJ, Awad RA, et al. Irritable bowel syndrome: an international study of symptoms in eight countries. Eur J Gastroenterol Hepatol. 2008; 20:659–667.

21. Ghoshal UC, Singh R. Frequency and risk factors of functional gastro-intestinal disorders in a rural Indian population. J Gastroenterol Hepatol. 2017; 32:378–387.

22. Kim SE. Importance of nutritional therapy in the management of intestinal diseases: beyond energy and nutrient supply. Intest Res. 2019; 17:443–454.

23. Gibson PR. History of the low FODMAP diet. J Gastroenterol Hepatol. 2017; 32 Suppl 1:5–7.

24. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014; 146:67–75.

25. Zhang Y, Feng L, Wang X, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet compared with traditional dietary advice for diarrhea-predominant irritable bowel syndrome: a parallel-group, randomized controlled trial with analysis of clinical and microbiological factors associated with patient outcomes. Am J Clin Nutr. 2021; 113:1531–1545.

26. Goyal O, Batta S, Nohria S, et al. Low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet in patients with diarrhea-predominant irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol Hepatol. 2021; 36:2107–2115.

27. Patcharatrakul T, Juntrapirat A, Lakananurak N, Gonlachanvit S. Effect of structural individual low-FODMAP dietary advice vs. brief advice on a commonly recommended diet on IBS symptoms and intestinal gas production. Nutrients. 2019; 11:2856.

28. Zhang Y, Ma ZF, Zhang H, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polypols diet and irritable bowel syndrome in Asia. JGH Open. 2018; 3:173–178.

29. Na W, Lee Y, Kim H, Kim YS, Sohn C. High-fat foods and FODMAPs containing gluten foods primarily contribute to symptoms of irritable bowel syndrome in Korean adults. Nutrients. 2021; 13:1308.

30. Lee HJ, Kim HJ, Kang EH, et al. Self-reported food intolerance in Korean patients with irritable bowel syndrome. J Neurogastroenterol Motil. 2019; 25:222–232.

31. Staudacher HM, Lomer MC, Anderson JL, et al. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr. 2012; 142:1510–1518.

32. Staudacher HM, Lomer M, Farquharson FM, et al. A diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and a probiotic restores Bifidobacterium species: a randomized controlled trial. Gastroenterology. 2017; 153:936–947.

33. Staudacher HM, Ralph F, Irving PM, Whelan K, Lomer M. Nutrient intake, diet quality, and diet diversity in irritable bowel syndrome and the impact of the low FODMAP diet. J Acad Nutr Diet. 2020; 120:535–547.

34. Black CJ, Staudacher HM, Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut. 2022; 71:1117–1126.

35. Ramakrishna BS, Makharia GK, Chetri K, et al. Prevalence of adult celiac disease in India: regional variations and associations. Am J Gastroenterol. 2016; 111:115–123.

36. Mohta S, Rajput MS, Ahuja V, Makharia GK. Emergence of celiac disease and gluten-related disorders in Asia. J Neurogastroenterol Motil. 2021; 27:337–346.

37. Potter M, Walker MM, Keely S, Talley NJ. What’s in a name? ‘Non-coeliac gluten or wheat sensitivity’: controversies and mechanisms related to wheat and gluten causing gastrointestinal symptoms or disease. Gut. 2018; 67:2073–2077.

38. Irvine AJ, Chey WD, Ford AC. Screening for celiac disease in irritable bowel syndrome: an updated systematic review and meta-analysis. Am J Gastroenterol. 2017; 112:65–76.

39. Rej A, Aziz I, Tornblom H, Sanders DS, Simrén M. The role of diet in irritable bowel syndrome: implications for dietary advice. J Intern Med. 2019; 286:490–502.

40. Bennet S, Böhn L, Störsrud S, 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.

41. Staudacher HM, Rossi M, Kaminski T, et al. Long-term personalized low FODMAP diet improves symptoms and maintains luminal Bifidobacteria abundance in irritable bowel syndrome. Neurogastroenterol Motil. 2022; 34:e14241.

42. Naseri K, Dabiri H, Rostami-Nejad M, et al. Influence of low FODMAP-gluten free diet on gut microbiota alterations and symptom severity in Iranian patients with irritable bowel syndrome. BMC Gastroenterol. 2021; 21:292.

43. Deutsch JK, Levitt J, Hass DJ. Complementary and alternative medicine for functional gastrointestinal disorders. Am J Gastroenterol. 2020; 115:350–364.

44. Alammar N, Wang L, Saberi B, et al. The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. BMC Complement Altern Med. 2019; 19:21.

45. Merat S, Khalili S, Mostajabi P, Ghorbani A, Ansari R, Malekzadeh R. The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Dig Dis Sci. 2010; 55:1385–1390.

46. Alam MS, Roy PK, Miah AR, et al. Efficacy of Peppermint oil in diarrhea predominant IBS-a double blind randomized placebo-controlled study. Mymensingh Med J. 2013; 22:27–30.

47. Fukudo S, Kaneko H, Akiho H, et al. Evaluation of Kampo medicine in the clinical practice guideline for irritable bowel syndrome. J Gastroenterol. 2015; 50:817–818.

48. Xiao Y, Liu Y, Huang S, et al. The efficacy of Shugan Jianpi Zhixie therapy for diarrhea-predominant irritable bowel syndrome: a meta-analysis of randomized, double-blind, placebo-controlled trials. PLoS One. 2015; 10:e0122397.

49. Chen M, Tang TC, Wang Y, et al. Randomised clinical trial: Tong-Xie-Yao-Fang granules versus placebo for patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2018; 48:160–168.

50. Wang XY, Wang H, Guan YY, Cai RL, Shen GM. Acupuncture for functional gastrointestinal disorders: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2021; 36:3015–3026.