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The symptoms of irritable bowel syndrome are estimated in 10-20% of the population, and the disease is currently one of the most common diseases of the digestive system. Thus, it is a significant diagnostic problem for doctors and nutritionists in terms of the selection the appropriate diet therapy and for pharmacists in terms of potential pharmaceutical care and consultation on basic nutritional errors. Research shows that the prevalence of IBS contributes to a significant deterioration in the quality of life, and the type of food consumed has a significant impact on the well-being and health of the patient. The prevelance of symptoms is strongly related to the food consumed. About 60% of patients diagnosed with Irritable Bowel Syndrome notice an exacerbation in symptoms and a deterioration of well-being soon after eating a meal. Among them, 28% of people report symptoms as early as 15 minutes after eating, while in over 93% of patients, severe symptoms persist for about 3 hours after stopping eating. The main treatments for IBS are diet modification and pharmacotherapy. Diet modification consists in temporarily eliminating the intake of certain foods (e.g. containing fermentable carbohydrates, lactose, gluten) or increasing the intake of dietary fiber or short-chain fatty acids. The Low-FODMAP diet draws particular attention in the nutritional treatment of irritable bowel syndrome.Its main assumption is the elimination of fermentable components in the intestinal lumen, which significantly reduces the symptoms of IBS. Medical data do not give a clear answer about the effectiveness of the Low-FODMAP diet, indicating many inaccuracies in the methodology of the conducted research, as well as pointing to the potential bias of the results. However, it seems paausible to say that the diet seems to be effective for the relief of single symptoms (abdominal pain, flatulence). An improperly implemented Low-FODMAP diet can induce deficiencies of certain vitamins and minerals and reduce the diversity of the bacterial microflora. Unfortunately, it is disturbing that, according to statistics, only 21% of doctors recommend that their patients consult a dietitian for nutrition, and there is no objective data in the field of pharmacy advice. The aim of the work was to present the principles and assumptions of the Low-FODMAP diet and dietary interventions that can be implemented in the treatment of IBS.

Background and objective Recently, dietary restriction of fermentable carbohydrates (a low-FODMAP diet) in combination with a gluten-free diet (GFD) has been proposed to reduce the symptoms in irritable bowel syndrome (IBS) patients. Different studies reported that IBS has been associated with dysbiosis in the gut microbiota. Additionally, a few studies have reported inflammation in the gastrointestinal (GI) system of adults with IBS. In this study, we aimed to investigate the effects of low FODMAP-gluten free diet (LF-GFD) on clinical symptoms, intestinal microbiota diversity, and fecal calprotectin (FC) level in Iranian patients with IBS. Design In this clinical trial study, 42 patients with IBS (Rome IV criteria) underwent LF-GFD intervention for 6 weeks. Symptoms were assessed using the IBS symptom severity scoring (IBS-SSS), and fecal samples were collected at baseline and after intervention and analyzed by quantitative 16 S rRNA PCR assay. The diversity of gut microbiota compared before and after 6 weeks of dietary intervention. FC was also analyzed by the ELISA method. Results Thirty patients (mean age 37.8 ± 10.7 years) completed the 6-week diet. The IBS-SSS was significantly (P = 0.001) reduced after LF-GFD intervention compared to the baseline. Significant microbial differences before and after intervention were noticed in fecal samples. A significant increase was found in Bacteroidetes, and the Firmicutes to Bacteroidetes (F/B) ratio was significantly (P = 0.001) decreased after the dietary intervention. The value of FC was significantly decreased after 6 weeks of dietary intervention (P = 0.001). Conclusions Our study suggests that patients with IBS under an LF-GFD had a significant improvement in IBS symptoms severity, with reduced FC level following normalization of their gut microbiota composition. Further rigorous trials are needed to establish a long-term efficacy and safety of this dietary intervention for personalized nutrition in IBS. Clinical Trial Registry Number: IRCT20100524004010N26.

Irritable bowel syndrome (IBS) or irritable bowel disease (IBD), is also known as spastic colitis, mucus colitis, and nervous colon. It is a chronic, or long-term, condition, but symptoms tend to change over the years. It’s not uncommon for people with IBS to have episodes of both constipation and diarrhea. Symptoms such as bloating and gas typically go away after a bowel movement. There is no cure for IBS. Treatment is aimed at symptom relief. Certain foods as well as stress and anxiety can be triggers for IBS symptoms for many people. Medications are available to ease the symptoms of IBS, but some patients feel better trying natural remedies instead of (or in addition to) conventional drugs. Objective of the Study: To detail conventional and alternative treatment approaches of IBS. Limitation of The Study: Surgical considerations of IBS patients are not included in this article. Findings: Lifestyle modification, specially food habit alteration mostly effective along with psychological counseling and medication adherence. Practical Implications: GPs, gastroenterologists, medicine specialists, pharmacy and medical students will get best benefit out of this article.

About 30% to 40% of adults claim to have frequent indigestion, and over 50 million visits are made annually to ambulatory care facilities for symptoms related to the digestive system. Irritable bowel syndrome (IBS) is present in patients with symptoms of chronic abdominal pain and altered bowel habits but no identifiable organic etiology. IBS has a prevalence of 1% to 20% worldwide, although up to 75% affected individuals never seek care. Diagnosing IBS can be challenging due to the nonspecific nature of symptoms, overlapping upper and lower abdominal symptoms, and the frequent presence of somatic and psychological comorbidities. Up to 80% of IBS patients identify food as a possible trigger for their symptoms, so they increasingly ask for dietary and behavioral counseling. Moderate-severe IBS is estimated to account for around 60% of all IBS cases and has been shown to impose a considerable burden on patients. It is estimated that IBS-C accounts for around 30% of IBS cases. The economic burden of IBS in the US is estimated at $28 billion annually, a portion of these costs may be related to unnecessary and high-frequency tests, although few studies have assessed the factors underlying frequent tests and procedures among patients with IBS. 32% of IBS-C patients suffer depression as their condition almost every day in the previous month. Sexual dysfunction is positively associated with perceived GI symptom severity and HRQoL.