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This article is based on scientific evidence, written by experts and fact checked by experts.

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This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

IBS Treatment Plan for Bloating, Constipation, and Diarrhea

Written by Michael Ruscio on October 24, 2020

Hilary Watts

Written by Michael Ruscio on October 24, 2020 — Reviewed by Hilary Watts Hilary Watts

How Diet, Lifestyle, and Treating Dysbiosis Can Relieve IBS Symptoms

ibs treatment: woman suffering from abdominal pain

If you have chronic digestive symptoms that are the hallmark of irritable bowel syndrome (IBS), you have probably searched far and wide for a good IBS treatment plan. You might wonder about the best way to approach IBS treatment.

Your ideal IBS treatment plan will depend on your particular IBS symptoms and causes, because these are unique for each IBS patient. But the general approach to treating IBS is the same as treating any other digestive symptoms or diseases:

  1. Eat an anti-inflammatory diet.
  2. Support your digestion with probiotics and other basic digestive supports.
  3. Include behavioral supports such as a stress relief practice if indicated.
  4. Treat any underlying dysbiosis if diet and digestive support don’t resolve symptoms.
  5. Maintain normal gut motility with natural items or prescription medications if necessary.
Steps involved in IBS treatment plan

What Is Irritable Bowel Syndrome (IBS)?

Irritable bowel syndrome (IBS) is one of the most common digestive system disorders, affecting approximately 10-15% of Americans [1]. IBS is not a specific disease with a specific cause — it’s a collection of digestive, immune system, and nervous system symptoms [2].

IBS Symptoms

Common symptoms of IBS include the following:

  • Cramping or abdominal pain
  • Gas
  • Bloating
  • Diarrhea (IBS-D)
  • Constipation (IBS-C)
  • Food allergies

IBS can also have some non-digestive symptoms including:

  • Brain fog and cognitive effects [3, 4]
  • Joint pain or body pain [5, 6, 7]
  • Fatigue [8]
  • Headaches [9, 10]

The official Rome IV criteria [11] for diagnosing IBS is “Recurrent abdominal pain on average at least one day/week in the last three months, associated with two or more of the following criteria:

  1. Related to defecation
  2. Associated with a change in the frequency of stool
  3. Associated with a change in the form (appearance) of stool” [12].

Essentially, changes in your bowel movements coupled with frequent abdominal pain from an unknown cause are called IBS.

How Is IBS Diagnosed?

There are no specific blood tests or other diagnostic tests for IBS. Research tells us that IBS symptoms are common in other digestive diseases such as inflammatory bowel disease (IBD) [13] and celiac disease [14]. Usually, an IBS diagnosis is made after your doctor or gastroenterologist rules out other causes for your digestive symptoms. 

Care providers may run basic blood tests, SIBO breath tests, or a colonoscopy to check the large intestine for visible problems. If nothing clear emerges from the testing and you meet the Rome IV criteria for IBS [15], you’ll be diagnosed with IBS [16].

IBS Causes

Research suggests there are many possible reasons why a digestive system develops IBS [17]. It has recently become clear that a portion of IBS cases are caused by bacterial infections. One study estimates that 5%-32% of IBS cases are caused by food poisoning [18]. Several other studies suggest a significant portion of IBS patients also have small intestine bacterial overgrowth (SIBO) or other types of bacterial imbalance [19, 20, 21].

Leaky gut [22, 23] or immune system imbalance [24] may be other causes of IBS. Other research suggests the neurotransmitter serotonin plays an important role in gut motility, and a serotonin imbalance may affect bowel function and IBS pain symptoms [25]. Fortunately, you don’t need to know the specific cause of your IBS to create an effective treatment strategy. Let’s discuss how to approach IBS treatment.

ibs treatment: assorted healthy food in a table

Home Remedies and Lifestyle Changes for IBS Treatment

A few targeted diet and lifestyle changes can make a big difference in your IBS symptoms. Let’s review the approaches that have been validated by scientific studies.

Dietary Changes

Adopting an anti-inflammatory diet is one of the most accessible steps you can take to reduce digestive system inflammation. Removing foods that may be irritating your digestive tract can help improve your quality of life and your IBS symptoms.

One of the most scientifically validated diets for IBS patients is the low FODMAP diet [26, 27]. FODMAP is an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are complex natural sugars and starches that can be difficult for some people to digest.

Some IBS patients are sensitive to one or more FODMAP categories. FODMAP foods, such as those high in fructose, can cause digestive tract irritation.

Research shows removing high FODMAP foods can improve symptoms for IBS patients. Two systematic reviews and meta-analyses showed that the low FODMAP diet reduced digestive symptoms and abdominal pain, and increased quality of life [28, 29].

Other studies show that the low FODMAP diet:

  • Improves diarrhea in IBS-D [30]
  • Improves IBS symptom [31, 32]

Other dietary changes that may be helpful for IBS symptoms include the Paleo diet and the elemental diet.

Digestive Support Supplements for IBS Treatment

Along with dietary changes, a few particular digestive health supplements may be useful for IBS.

Probiotics, Bloating, & IBS

Probiotics have been shown in five separate meta-analyses (the highest quality scientific evidence) and multiple clinical trials to improve IBS symptoms, especially bloating and abdominal pain [33, 34, 35, 36, 37]. These studies showed probiotics improved the following IBS symptoms more than a placebo:

  • Diarrhea, or loose stools
  • Constipation
  • Bloating and abdominal pain
  • Flatulence or gas
  • Fatigue and difficulty sleeping

Probiotics may also improve non-digestive IBS symptoms, including joint or body pain [38, 39, 40] and brain fog [41, 42].

Research suggests that probiotics generally improve IBS symptoms, but there aren’t yet recommendations about specific probiotic species or strains [43]. This is likely due to the fact that probiotics don’t work like medications but instead generally improve gut health.

chart of how probiotics work

Two systematic reviews and meta-analyses indicate that multi-strain probiotics are more effective than single-strain probiotics in the treatment of IBS [44, 45]. Multi-strain probiotics were also found to perform better in a meta-analysis of studies using probiotics to treat constipation [46].

My experience in the clinic mirrors this research. When patients use three types of probiotics together, they often see symptom improvement they didn’t see by using only one probiotic.

Digestive Enzymes

Many IBS patients have symptoms flares because they have trouble digesting certain foods, like FODMAPs or dietary fats. A potential cause of IBS-D symptoms is exocrine pancreatic insufficiency (EPI), where the body doesn’t produce enough pancreatic enzymes [47]. A meta-analysis showed that pancreatic enzyme replacement therapy improved symptoms compared to a placebo [48]. One additional small study found that digestive enzymes improved symptoms for IBS and IBD patients [49]. Including digestive enzymes may improve IBS symptoms for some IBS patients.

What About Fiber Supplements?

Fiber supplements like psyllium or Metamucil are often recommended for people with constipation. Research supports this practice [50]. A meta-analysis concluded that soluble fiber, like psyllium, improved global IBS symptoms [51]. Several individual studies support this conclusion [52, 53]. However, fiber supplements should be used with caution by IBS patients. For a significant portion of them, fiber triggers an increase in bloating, gas, and abdominal pain [54]. If you’re interested in trying fiber supplements, start low and slowly increase.

If you notice negative side effects, discontinue use immediately and try again when your gut has done some healing.

ibs treatment: girl meditating in bed

Lifestyle Changes for IBS Treatment

Successful treatment of IBS often includes lifestyle changes to reduce stress. Stress is a common trigger for IBS symptoms like diarrhea and constipation, and behavioral strategies can improve symptoms for some patients.

There are many ways to reduce stress, including time in nature, exercise, or spending time with a loved one. However, some people may find they need a higher level of support.

Some preliminary research suggests relaxation techniques such as cognitive behavioral therapy [55, 56], hypnotherapy [57, 58], and meditation [59] in your IBS treatment plan are likely helpful complementary therapies for IBS, improving symptoms by 20%-65% [60].

A systematic review suggested that exercise can also help reduce bloating, stress, and gas, but it concluded more high-quality research needs to be done [61].

Treatment of Underlying Dysbiosis

IBS symptoms have been shown to correlate with dysbiosis [62], particularly SIBO [63, 64, 65]. Dysbiosis is an imbalance in your normal gut flora. One study showed that one-third of IBS patients also tested positive for SIBO [66]. Another study concluded that IBS patients were five times more likely to test positive for SIBO than controls [67].

It’s common opinion that probiotics should not be used during SIBO treatment, but a meta-analysis clearly showed that probiotics help improve SIBO treatment outcomes [68]. This may be part of the reason why probiotics improve IBS.

Probiotics have been shown to help improve various types of dysbiosis, including SIBO [69, 70, 71], H.pylori infections [72, 73], parasitic infections [74], and fungal infections [75, 76]. For this reason, probiotics should be included in your IBS treatment plan early, as they can crowd out infections, and improve your overall gut health. 

But if you don’t experience much relief from diet changes, probiotics, and digestive support, or you reach an improvement plateau after giving them an appropriate trial, treating dysbiosis with herbal antimicrobials or prescription antibiotics can be an important part of your IBS treatment plan.

Talk with your doctor, or refer to my book Healthy Gut, Healthy You for more specifics about how to use antimicrobial treatment for IBS.

IBS Treatment: Using Medication to Maintain Gut Motility and Relieve Symptoms

Sometimes, despite their best efforts with diet and lifestyle, some patients find they need prescription or over-the-counter medications to manage IBS symptoms like bowel movement frequency. Or, once they’ve improved, they want to maintain their long-term symptom remission.

One of the most important IBS symptoms to keep in check is your gut motility, or the speed at which your gut contents move through your digestive tract. Too fast, and you have diarrhea. Too slow, and you have constipation.

Diet and habit changes can do a lot to help maintain your success, but some IBS symptoms aren’t responsive to these efforts. Or, some patients have anatomical problems, like abdominal adhesions or scar tissue, that prevent normal bowel function without outside support.

Here are some of the treatments that research supports. If you think you need additional support beyond diet and lifestyle, speak with your doctor about getting a prescription.

Medication for Bloating

For some IBS patients, bloating is the worst and most frustrating symptom. Some gastroenterologists and gut specialists prescribe antispasmodics such as Bentyl (Reglan) or Levsin (hyoscyamine), or peppermint oil.

Medication for Symptoms of IBS-D

The following medicines may be prescribed to reduce the number of daily bowel movements and improve your stool consistency.

  • Imodium(loperamide) is an over-the-counter medication that slows gut motility by relaxing the smooth muscles of the digestive system.
  • Viberzi (eluxadoline) is a prescription medication for IBS with diarrhea.
  • Lotronex (alosetron) is a prescription medication for women with IBS-D and trouble controlling their bowel movements.
  • Rifaximin (xifaximin) is an FDA-approved antibiotic for the treatment of IBS symptoms of diarrhea, bloating, and SIBO [77].

Bile Acid Malabsorption (BAM) can be an underlying cause of chronic diarrhea. In bile acid diarrhea, your body has too much bile acid in the intestines, causing watery diarrhea. An elevated level of steatocrit in the stool is a gold-standard test for bile acid diarrhea. Conventional treatment includes bile acid binders such as:

  • Cholestyramine
  • Colestipol
  • Welchol (colesevelam)

Medications for Symptoms of IBS-C and Gut Motility

If you struggle with constipation or slow gut motility, keeping your bowels moving at a normal pace is crucial for reducing recurrences of bacterial overgrowth and IBS symptoms. The following medications or supplements may be used to speed up your gut motility, soften your stool, and reduce the frequency or relapse of symptoms of IBS-C.

Natural Motility Support: The power of natural and herbal motility supports should not be overlooked. MotilPro, which contains high doses of ginger, and Iberogast, which contains an herbal formula to increase motility, have shown promise for many patients. These supplements work on some of the same mechanisms as prescription motility medications but may have fewer side effects.

Over-the-counter laxatives: Glycolax (or Miralax) or magnesium citrate can help keep you regular. Keeping regular is important for reducing the likelihood of small intestinal bacterial overgrowth (SIBO) [78]. If no other options have led to bowel regularity, medications can help you while you continue to work on solving your underlying causes.

Calcium channel activators: Prescription medications like Trulance (plecanatide) and Amitiza (lubiprostone) activate the calcium channel and act as a laxative.

Serotonin enhancement: For some patients, serotonin metabolism in the digestive tract tissue may be involved with constipation [79], and some providers prescribe selective serotonin reuptake inhibitors (SSRIs) or low-dose tricyclic antidepressants for constipation [80]. But these medications carry risks of undesired side effects [81].

Medications with the most promise and the least amount of side effects include:

  • Low Dose Naltrexone (LDN)
  • Motegrity, Resolor (prucalopride) Prucalopride was recently approved by the FDA for use in the United States.
  • Linzess (linaclotide)

Serum Bovine Immunoglobulins

Immunoglobulins are a relatively new supplement that have been shown to be helpful for patients who have already tried diet changes, gut soothers, probiotics, and antimicrobial treatment without results. Immunoglobulins support the gut immune system by binding to and neutralizing bad bacteria and toxins.

Multiple clinical trials have shown that serum bovine immunoglobulins improve IBS symptoms [82, 83, 84, 85, 86, 87, 88]. In one exciting study, in patients with IBS or SIBO (or both) who didn’t respond to other treatments, serum bovine immunoglobulins (SBIs) improved symptoms an impressive 75% [89].

It’s important to always start with diet, probiotics, and antimicrobial treatment for IBS. But for patients who don’t respond to these options, SBIs are worth a serious look.

Create Your Customized IBS Treatment Plan for Relief

With the right combination of diet, lifestyle, and medical treatment, you can get your IBS symptoms under control so you can enjoy life again. Adopt a low FODMAP diet, include basic digestive support supplements including probiotics, lifestyle changes, dysbiosis treatment, and medications if necessary to balance your motility for best results.

If you need help creating a plan, see my book Healthy Gut, Healthy You, or reach out to our clinic or our health coach for guidance.

Dr. Michael Ruscio is a DC, natural health provider, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

➕ References

  1. https://gi.org/topics/irritable-bowel-syndrome/
  2. Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015 Mar 3;313(9):949-58. doi: 10.1001/jama.2015.0954. PMID: 25734736.
  3. Hausteiner-Wiehle C, Henningsen P. Irritable bowel syndrome: relations with functional, mental, and somatoform disorders. World J Gastroenterol. 2014 May 28;20(20):6024-30. doi: 10.3748/wjg.v20.i20.6024. PMID: 24876725; PMCID: PMC4033442.
  4. Frändemark Å, Jakobsson Ung E, Törnblom H, Simrén M, Jakobsson S. Fatigue: a distressing symptom for patients with irritable bowel syndrome. Neurogastroenterol Motil. 2017 Jan;29(1). doi: 10.1111/nmo.12898. Epub 2016 Jul 11. PMID: 27401139.
  5. Chakiath RJ, Siddall PJ, Kellow JE, Hush JM, Jones MP, Marcuzzi A, Wrigley PJ. Descending pain modulation in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Syst Rev. 2015 Dec 10;4:175. doi: 10.1186/s13643-015-0162-8. PMID: 26652749; PMCID: PMC4674951.
  6. Berstad A, Undseth R, Lind R, Valeur J. Functional bowel symptoms, fibromyalgia and fatigue: a food-induced triad? Scand J Gastroenterol. 2012 Sep;47(8-9):914-9. doi: 10.3109/00365521.2012.690045. Epub 2012 May 18. PMID: 22594347; PMCID: PMC3793273.
  7. Nilholm C, Roth B, Ohlsson B. A Dietary Intervention with Reduction of Starch and Sucrose Leads to Reduced Gastrointestinal and Extra-Intestinal Symptoms in IBS Patients. Nutrients. 2019 Jul 20;11(7):1662. doi: 10.3390/nu11071662. PMID: 31330810; PMCID: PMC6682926.
  8. Han CJ, Yang GS. Fatigue in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis of Pooled Frequency and Severity of Fatigue. Asian Nurs Res (Korean Soc Nurs Sci). 2016 Mar;10(1):1-10. doi: 10.1016/j.anr.2016.01.003. Epub 2016 Feb 1. PMID: 27021828.
  9. Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A. Gastrointestinal disorders associated with migraine: A comprehensive review. World J Gastroenterol. 2016 Sep 28;22(36):8149-60. doi: 10.3748/wjg.v22.i36.8149. PMID: 27688656; PMCID: PMC5037083.
  10. Arzani M, Jahromi SR, Ghorbani Z, Vahabizad F, Martelletti P, Ghaemi A, Sacco S, Togha M; School of Advanced Studies of the European Headache Federation (EHF-SAS). Gut-brain Axis and migraine headache: a comprehensive review. J Headache Pain. 2020 Feb 13;21(1):15. doi: 10.1186/s10194-020-1078-9. PMID: 32054443; PMCID: PMC7020496.
  11. Lacy BE, Patel NK. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. J Clin Med. 2017 Oct 26;6(11):99. doi: 10.3390/jcm6110099. PMID: 29072609; PMCID: PMC5704116.
  12. Lacy BE, Patel NK. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. J Clin Med. 2017 Oct 26;6(11):99. doi: 10.3390/jcm6110099. PMID: 29072609; PMCID: PMC5704116.
  13. Halpin SJ, Ford AC. Prevalence of symptoms meeting criteria for irritable bowel syndrome in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2012 Oct;107(10):1474-82. doi: 10.1038/ajg.2012.260. Epub 2012 Aug 28. PMID: 22929759.
  14. Sainsbury A, Sanders DS, Ford AC. Prevalence of irritable bowel syndrome-type symptoms in patients with celiac disease: a meta-analysis. Clin Gastroenterol Hepatol. 2013 Apr;11(4):359-65.e1. doi: 10.1016/j.cgh.2012.11.033. Epub 2012 Dec 13. PMID: 23246645.
  15. Lacy BE, Patel NK. Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome. J Clin Med. 2017 Oct 26;6(11):99. doi: 10.3390/jcm6110099. PMID: 29072609; PMCID: PMC5704116.
  16. Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015 Mar 3;313(9):949-58. doi: 10.1001/jama.2015.0954. PMID: 25734736.
  17. Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015 Mar 3;313(9):949-58. doi: 10.1001/jama.2015.0954. PMID: 25734736.
  18. Thabane M, Marshall JK. Post-infectious irritable bowel syndrome. World J Gastroenterol. 2009 Aug 7;15(29):3591-6. doi: 10.3748/wjg.15.3591. PMID: 19653335; PMCID: PMC2721231.
  19. Chen B, Kim JJ, Zhang Y, Du L, Dai N. Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis. J Gastroenterol. 2018 Jul;53(7):807-818. doi: 10.1007/s00535-018-1476-9. Epub 2018 May 14. PMID: 29761234.
  20. Schmulson M, Bielsa MV, Carmona-Sánchez R, Hernández A, López-Colombo A, López Vidal Y, Peláez-Luna M, Remes-Troche JM, Tamayo JL, Valdovinos MA. Microbiota, gastrointestinal infections, low-grade inflammation, and antibiotic therapy in irritable bowel syndrome: an evidence-based review. Rev Gastroenterol Mex. 2014 Apr-Jun;79(2):96-134. English, Spanish. doi: 10.1016/j.rgmx.2014.01.004. Epub 2014 May 23. PMID: 24857420.
  21. Takakura W, Pimentel M. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update. Front Psychiatry. 2020 Jul 10;11:664. doi: 10.3389/fpsyt.2020.00664. PMID: 32754068; PMCID: PMC7366247.
  22. Camilleri M, Gorman H. Intestinal permeability and irritable bowel syndrome. Neurogastroenterol Motil. 2007 Jul;19(7):545-52. doi: 10.1111/j.1365-2982.2007.00925.x. PMID: 17593135.
  23. Barbara G. Mucosal barrier defects in irritable bowel syndrome. Who left the door open? Am J Gastroenterol. 2006 Jun;101(6):1295-8. doi: 10.1111/j.1572-0241.2006.00667.x. PMID: 16771952.
  24. Barbara G, Cremon C, Carini G, Bellacosa L, Zecchi L, De Giorgio R, Corinaldesi R, Stanghellini V. The immune system in irritable bowel syndrome. J Neurogastroenterol Motil. 2011 Oct;17(4):349-59. doi: 10.5056/jnm.2011.17.4.349. Epub 2011 Oct 31. PMID: 22148103; PMCID: PMC3228974.
  25. Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015 Mar 3;313(9):949-58. doi: 10.1001/jama.2015.0954. PMID: 25734736.
  26. Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016 Apr;55(3):897-906. doi: 10.1007/s00394-015-0922-1. Epub 2015 May 17. PMID: 25982757.
  27. Altobelli E, Del Negro V, Angeletti PM, Latella G. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017 Aug 26;9(9):940. doi: 10.3390/nu9090940. PMID: 28846594; PMCID: PMC5622700.
  28. Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016 Apr;55(3):897-906. doi: 10.1007/s00394-015-0922-1. Epub 2015 May 17. PMID: 25982757.
  29. Altobelli E, Del Negro V, Angeletti PM, Latella G. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017 Aug 26;9(9):940. doi: 10.3390/nu9090940. PMID: 28846594; PMCID: PMC5622700.
  30. Zahedi MJ, Behrouz V, Azimi M. Low fermentable oligo-di-mono-saccharides and polyols diet versus general dietary advice in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled trial. J Gastroenterol Hepatol. 2018 Jun;33(6):1192-1199. doi: 10.1111/jgh.14051. Epub 2018 Feb 21. PMID: 29159993.
  31. Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016 Apr;55(3):897-906. doi: 10.1007/s00394-015-0922-1. Epub 2015 May 17. PMID: 25982757.
  32. Altobelli E, Del Negro V, Angeletti PM, Latella G. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017 Aug 26;9(9):940. doi: 10.3390/nu9090940. PMID: 28846594; PMCID: PMC5622700.
  33. Yuan F, Ni H, Asche CV, Kim M, Walayat S, Ren J. Efficacy of Bifidobacterium infantis 35624 in patients with irritable bowel syndrome: a meta-analysis. Curr Med Res Opin. 2017 Jul;33(7):1191-1197. doi: 10.1080/03007995.2017.1292230. Epub 2017 Mar 7. PMID: 28166427.
  34. Tiequn B, Guanqun C, Shuo Z. Therapeutic effects of Lactobacillus in treating irritable bowel syndrome: a meta-analysis. Intern Med. 2015;54(3):243-9. doi: 10.2169/internalmedicine.54.2710. PMID: 25748731.
  35. McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008 May 7;14(17):2650-61. doi: 10.3748/wjg.14.2650. PMID: 18461650; PMCID: PMC2709042.
  36. Whelan K. Probiotics and prebiotics in the management of irritable bowel syndrome: a review of recent clinical trials and systematic reviews. Curr Opin Clin Nutr Metab Care. 2011 Nov;14(6):581-7. doi: 10.1097/MCO.0b013e32834b8082. PMID: 21892075.
  37. Ford AC, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BM, Moayyedi P. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014 Oct;109(10):1547-61; quiz 1546, 1562. doi: 10.1038/ajg.2014.202. Epub 2014 Jul 29. PMID: 25070051.
  38. Chakiath RJ, Siddall PJ, Kellow JE, Hush JM, Jones MP, Marcuzzi A, Wrigley PJ. Descending pain modulation in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Syst Rev. 2015 Dec 10;4:175. doi: 10.1186/s13643-015-0162-8. PMID: 26652749; PMCID: PMC4674951.
  39. Berstad A, Undseth R, Lind R, Valeur J. Functional bowel symptoms, fibromyalgia and fatigue: a food-induced triad? Scand J Gastroenterol. 2012 Sep;47(8-9):914-9. doi: 10.3109/00365521.2012.690045. Epub 2012 May 18. PMID: 22594347; PMCID: PMC3793273.
  40. Nilholm C, Roth B, Ohlsson B. A Dietary Intervention with Reduction of Starch and Sucrose Leads to Reduced Gastrointestinal and Extra-Intestinal Symptoms in IBS Patients. Nutrients. 2019 Jul 20;11(7):1662. doi: 10.3390/nu11071662. PMID: 31330810; PMCID: PMC6682926.
  41. Hausteiner-Wiehle C, Henningsen P. Irritable bowel syndrome: relations with functional, mental, and somatoform disorders. World J Gastroenterol. 2014 May 28;20(20):6024-30. doi: 10.3748/wjg.v20.i20.6024. PMID: 24876725; PMCID: PMC4033442.
  42. Frändemark Å, Jakobsson Ung E, Törnblom H, Simrén M, Jakobsson S. Fatigue: a distressing symptom for patients with irritable bowel syndrome. Neurogastroenterol Motil. 2017 Jan;29(1). doi: 10.1111/nmo.12898. Epub 2016 Jul 11. PMID: 27401139.
  43. Ford AC, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BM, Moayyedi P. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014 Oct;109(10):1547-61; quiz 1546, 1562. doi: 10.1038/ajg.2014.202. Epub 2014 Jul 29. PMID: 25070051.
  44. American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009 Jan;104 Suppl 1:S1-35. doi: 10.1038/ajg.2008.122. PMID: 19521341.
  45. Ford AC, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BM, Moayyedi P. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014 Oct;109(10):1547-61; quiz 1546, 1562. doi: 10.1038/ajg.2014.202. Epub 2014 Jul 29. PMID: 25070051.
  46. Zhang C, Jiang J, Tian F, Zhao J, Zhang H, Zhai Q, Chen W. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 2020 Oct;39(10):2960-2969. doi: 10.1016/j.clnu.2020.01.005. Epub 2020 Jan 14. PMID: 32005532.
  47. Alkaade S, Vareedayah AA. A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities. Am J Manag Care. 2017 Jul;23(12 Suppl):S203-S209. PMID: 28727474.
  48. Alkaade S, Vareedayah AA. A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities. Am J Manag Care. 2017 Jul;23(12 Suppl):S203-S209. PMID: 28727474.
  49. Spagnuolo R, Cosco C, Mancina RM, Ruggiero G, Garieri P, Cosco V, Doldo P. Beta-glucan, inositol and digestive enzymes improve quality of life of patients with inflammatory bowel disease and irritable bowel syndrome. Eur Rev Med Pharmacol Sci. 2017 Jun;21(2 Suppl):102-107. PMID: 28724171.
  50. El-Salhy M, Ystad SO, Mazzawi T, Gundersen D. Dietary fiber in irritable bowel syndrome (Review). Int J Mol Med. 2017 Sep;40(3):607-613. doi: 10.3892/ijmm.2017.3072. Epub 2017 Jul 19. PMID: 28731144; PMCID: PMC5548066.
  51. Moayyedi P, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BM, Ford AC. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. 2014 Sep;109(9):1367-74. doi: 10.1038/ajg.2014.195. Epub 2014 Jul 29. PMID: 25070054.
  52. Furnari M, de Bortoli N, Martinucci I, Bodini G, Revelli M, Marabotto E, Moscatelli A, Del Nero L, Savarino E, Giannini EG, Savarino V. Optimal management of constipation associated with irritable bowel syndrome. Ther Clin Risk Manag. 2015 May 30;11:691-703. doi: 10.2147/TCRM.S54298. PMID: 26028974; PMCID: PMC4425337.
  53. Bellini M, Gambaccini D, Salvadori S, Tosetti C, Urbano MT, Costa F, Monicelli P, Mumolo MG, Ricchiuti A, De Bortoli N, Marchi S. Management of chronic constipation in general practice. Tech Coloproctol. 2014 Jun;18(6):543-9. doi: 10.1007/s10151-013-1093-9. Epub 2013 Nov 22. PMID: 24272606.
  54. El-Salhy M, Ystad SO, Mazzawi T, Gundersen D. Dietary fiber in irritable bowel syndrome (Review). Int J Mol Med. 2017 Sep;40(3):607-613. doi: 10.3892/ijmm.2017.3072. Epub 2017 Jul 19. PMID: 28731144; PMCID: PMC5548066.
  55. Zhao SR, Ni XM, Zhang XA, Tian H. Effect of cognitive behavior therapy combined with exercise intervention on the cognitive bias and coping styles of diarrhea-predominant irritable bowel syndrome patients. World J Clin Cases. 2019 Nov 6;7(21):3446-3462. doi: 10.12998/wjcc.v7.i21.3446. PMID: 31750328; PMCID: PMC6854400.
  56. Lackner JM, Jaccard J, Keefer L, Brenner DM, Firth RS, Gudleski GD, Hamilton FA, Katz LA, Krasner SS, Ma CX, Radziwon CD, Sitrin MD. Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome. Gastroenterology. 2018 Jul;155(1):47-57. doi: 10.1053/j.gastro.2018.03.063. Epub 2018 Apr 25. Erratum in: Gastroenterology. 2018 Oct;155(4):1281. PMID: 29702118; PMCID: PMC6035059.
  57. Peters SL, Muir JG, Gibson PR. Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease. Aliment Pharmacol Ther. 2015 Jun;41(11):1104-15. doi: 10.1111/apt.13202. Epub 2015 Apr 10. PMID: 25858661.
  58. Miller V, Carruthers HR, Morris J, Hasan SS, Archbold S, Whorwell PJ. Hypnotherapy for irritable bowel syndrome: an audit of one thousand adult patients. Aliment Pharmacol Ther. 2015 May;41(9):844-55. doi: 10.1111/apt.13145. Epub 2015 Mar 4. PMID: 25736234.
  59. Shah K, Ramos-Garcia M, Bhavsar J, Lehrer P. Mind-body treatments of irritable bowel syndrome symptoms: An updated meta-analysis. Behav Res Ther. 2020 May;128:103462. doi: 10.1016/j.brat.2019.103462. Epub 2019 Nov 12. PMID: 32229334.
  60. Lackner JM, Jaccard J, Keefer L, Brenner DM, Firth RS, Gudleski GD, Hamilton FA, Katz LA, Krasner SS, Ma CX, Radziwon CD, Sitrin MD. Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome. Gastroenterology. 2018 Jul;155(1):47-57. doi: 10.1053/j.gastro.2018.03.063. Epub 2018 Apr 25. Erratum in: Gastroenterology. 2018 Oct;155(4):1281. PMID: 29702118; PMCID: PMC6035059.
  61. Zhou C, Zhao E, Li Y, Jia Y, Li F. Exercise therapy of patients with irritable bowel syndrome: A systematic review of randomized controlled trials. Neurogastroenterol Motil. 2019 Feb;31(2):e13461. doi: 10.1111/nmo.13461. Epub 2018 Sep 19. PMID: 30232834.
  62. Wang L, Alammar N, Singh R, Nanavati J, Song Y, Chaudhary R, Mullin GE. Gut Microbial Dysbiosis in the Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Case-Control Studies. J Acad Nutr Diet. 2020 Apr;120(4):565-586. doi: 10.1016/j.jand.2019.05.015. Epub 2019 Aug 28. PMID: 31473156.
  63. Schmulson M, Bielsa MV, Carmona-Sánchez R, Hernández A, López-Colombo A, López Vidal Y, Peláez-Luna M, Remes-Troche JM, Tamayo JL, Valdovinos MA. Microbiota, gastrointestinal infections, low-grade inflammation, and antibiotic therapy in irritable bowel syndrome: an evidence-based review. Rev Gastroenterol Mex. 2014 Apr-Jun;79(2):96-134. English, Spanish. doi: 10.1016/j.rgmx.2014.01.004. Epub 2014 May 23. PMID: 24857420.
  64. Takakura W, Pimentel M. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update. Front Psychiatry. 2020 Jul 10;11:664. doi: 10.3389/fpsyt.2020.00664. PMID: 32754068; PMCID: PMC7366247.
  65. Saffouri GB, Shields-Cutler RR, Chen J, Yang Y, Lekatz HR, Hale VL, Cho JM, Battaglioli EJ, Bhattarai Y, Thompson KJ, Kalari KK, Behera G, Berry JC, Peters SA, Patel R, Schuetz AN, Faith JJ, Camilleri M, Sonnenburg JL, Farrugia G, Swann JR, Grover M, Knights D, Kashyap PC. Small intestinal microbial dysbiosis underlies symptoms associated with functional gastrointestinal disorders. Nat Commun. 2019 May 1;10(1):2012. doi: 10.1038/s41467-019-09964-7. PMID: 31043597; PMCID: PMC6494866.
  66. Chen B, Kim JJ, Zhang Y, Du L, Dai N. Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis. J Gastroenterol. 2018 Jul;53(7):807-818. doi: 10.1007/s00535-018-1476-9. Epub 2018 May 14. PMID: 29761234.
  67. Chen B, Kim JJ, Zhang Y, Du L, Dai N. Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis. J Gastroenterol. 2018 Jul;53(7):807-818. doi: 10.1007/s00535-018-1476-9. Epub 2018 May 14. PMID: 29761234.
  68. Zhong C, Qu C, Wang B, Liang S, Zeng B. Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. J Clin Gastroenterol. 2017 Apr;51(4):300-311. doi: 10.1097/MCG.0000000000000814. PMID: 28267052.
  69. Zhong C, Qu C, Wang B, Liang S, Zeng B. Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. J Clin Gastroenterol. 2017 Apr;51(4):300-311. doi: 10.1097/MCG.0000000000000814. PMID: 28267052.
  70. García-Collinot G, Madrigal-Santillán EO, Martínez-Bencomo MA, Carranza-Muleiro RA, Jara LJ, Vera-Lastra O, Montes-Cortes DH, Medina G, Cruz-Domínguez MP. Effectiveness of Saccharomyces boulardii and Metronidazole for Small Intestinal Bacterial Overgrowth in Systemic Sclerosis. Dig Dis Sci. 2020 Apr;65(4):1134-1143. doi: 10.1007/s10620-019-05830-0. Epub 2019 Sep 23. PMID: 31549334.
  71. Greco A, Caviglia GP, Brignolo P, Ribaldone DG, Reggiani S, Sguazzini C, Smedile A, Pellicano R, Resegotti A, Astegiano M, Bresso F. Glucose breath test and Crohn’s disease: Diagnosis of small intestinal bacterial overgrowth and evaluation of therapeutic response. Scand J Gastroenterol. 2015;50(11):1376-81. doi: 10.3109/00365521.2015.1050691. Epub 2015 May 19. PMID: 25990116.
  72. Eslami M, Yousefi B, Kokhaei P, Jazayeri Moghadas A, Sadighi Moghadam B, Arabkari V, Niazi Z. Are probiotics useful for therapy of Helicobacter pylori diseases? Comp Immunol Microbiol Infect Dis. 2019 Jun;64:99-108. doi: 10.1016/j.cimid.2019.02.010. Epub 2019 Mar 5. PMID: 31174707.
  73. Wang F, Feng J, Chen P, Liu X, Ma M, Zhou R, Chang Y, Liu J, Li J, Zhao Q. Probiotics in Helicobacter pylori eradication therapy: Systematic review and network meta-analysis. Clin Res Hepatol Gastroenterol. 2017 Sep;41(4):466-475. doi: 10.1016/j.clinre.2017.04.004. Epub 2017 May 25. PMID: 28552432.
  74. Besirbellioglu BA, Ulcay A, Can M, Erdem H, Tanyuksel M, Avci IY, Araz E, Pahsa A. Saccharomyces boulardii and infection due to Giardia lamblia. Scand J Infect Dis. 2006;38(6-7):479-81. doi: 10.1080/00365540600561769. PMID: 16798698.
  75. Demirel G, Celik IH, Erdeve O, Saygan S, Dilmen U, Canpolat FE. Prophylactic Saccharomyces boulardii versus nystatin for the prevention of fungal colonization and invasive fungal infection in premature infants. Eur J Pediatr. 2013 Oct;172(10):1321-6. doi: 10.1007/s00431-013-2041-4. Epub 2013 May 24. PMID: 23703468.
  76. Dinleyici EC, Eren M, Dogan N, Reyhanioglu S, Yargic ZA, Vandenplas Y. Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection. Parasitol Res. 2011 Mar;108(3):541-5. doi: 10.1007/s00436-010-2095-4. Epub 2010 Oct 5. PMID: 20922415.
  77. Barkin JA, Keihanian T, Barkin JS, Antequera CM, Moshiree B. Preferential usage of rifaximin for the treatment of hydrogen-positive smallintestinal bacterial overgrowth. Rev Gastroenterol Peru. 2019 Apr-Jun;39(2):111-115. English. PMID: 31333225.
  78. Miazga A, Osiński M, Cichy W, Żaba R. Current views on the etiopathogenesis, clinical manifestation, diagnostics, treatment and correlation with other nosological entities of SIBO. Adv Med Sci. 2015 Mar;60(1):118-24. doi: 10.1016/j.advms.2014.09.001. Epub 2014 Oct 6. PMID: 25657082.
  79. Miazga A, Osiński M, Cichy W, Żaba R. Current views on the etiopathogenesis, clinical manifestation, diagnostics, treatment and correlation with other nosological entities of SIBO. Adv Med Sci. 2015 Mar;60(1):118-24. doi: 10.1016/j.advms.2014.09.001. Epub 2014 Oct 6. PMID: 25657082.
  80. Zar-Kessler CAM, Belkind-Gerson J, Bender S, Kuo BM. Treatment of Functional Abdominal Pain With Antidepressants: Benefits, Adverse Effects, and the Gastroenterologist’s Role. J Pediatr Gastroenterol Nutr. 2017 Jul;65(1):16-21. doi: 10.1097/MPG.0000000000001416. PMID: 28644344.
  81. Zar-Kessler CAM, Belkind-Gerson J, Bender S, Kuo BM. Treatment of Functional Abdominal Pain With Antidepressants: Benefits, Adverse Effects, and the Gastroenterologist’s Role. J Pediatr Gastroenterol Nutr. 2017 Jul;65(1):16-21. doi: 10.1097/MPG.0000000000001416. PMID: 28644344.
  82. Wilson D, Evans M, Weaver E, Shaw AL, Klein GL. Evaluation of serum-derived bovine immunoglobulin protein isolate in subjects with diarrhea-predominant irritable bowel syndrome. Clin Med Insights Gastroenterol. 2013 Dec 5;6:49-60. doi: 10.4137/CGast.S13200. PMID: 24833942; PMCID: PMC4020402.
  83. Hilal, R. , Mitchell, P. , Guerra Jr., E. and Burnett, B. (2014) Case Series of 10 Drug-Refractory IBS Patients Who Respond to Oral Serum-Derived Bovine Immunoglobulin/Protein Isolate (SBI). Open Journal of Gastroenterology, 4, 321-328. doi: 10.4236/ojgas.2014.410046.
  84. Weinstock, L. and Jasion, V. (2014) Serum-Derived Bovine Immunoglobulin/Protein Isolate Therapy for Patients with Refractory Irritable Bowel Syndrome. Open Journal of Gastroenterology, 4, 329-334. doi: 10.4236/ojgas.2014.410047.
  85. Good L, Rosario R, Panas R. New therapeutic option for irritable bowel syndrome: serum-derived bovine immunoglobulin. World J Gastroenterol. 2015 Mar 21;21(11):3361-6. doi: 10.3748/wjg.v21.i11.3361. PMID: 25805945; PMCID: PMC4363768.
  86. http://www.ghrnet.org/index.php/joghr/article/view/900
  87. Valentin N, Camilleri M, Carlson P, Harrington SC, Eckert D, O’Neill J, Burton D, Chen J, Shaw AL, Acosta A. Potential mechanisms of effects of serum-derived bovine immunoglobulin/protein isolate therapy in patients with diarrhea-predominant irritable bowel syndrome. Physiol Rep. 2017 Mar;5(5):e13170. doi: 10.14814/phy2.13170. PMID: 28275113; PMCID: PMC5350178.
  88. Shaw AL, Tomanelli A, Bradshaw TP, Petschow BW, Burnett BP. Impact of serum-derived bovine immunoglobulin/protein isolate therapy on irritable bowel syndrome and inflammatory bowel disease: a survey of patient perspective. Patient Prefer Adherence. 2017 May 31;11:1001-1007. doi: 10.2147/PPA.S134792. PMID: 28615929; PMCID: PMC5460652.
  89. Weinstock, L. and Jasion, V. (2014) Serum-Derived Bovine Immunoglobulin/Protein Isolate Therapy for Patients with Refractory Irritable Bowel Syndrome. Open Journal of Gastroenterology, 4, 329-334. doi: 10.4236/ojgas.2014.410047.

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