Review article: Exclude or expose?
| Autor: | Jessica R. Biesiekierski, Lauren P. Manning, Helen Burton Murray, Johan W. S. Vlaeyen, Brjánn Ljótsson, Lukas Van Oudenhove |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Clinical Trials as Topic
Cognitive Behavioral Therapy Hepatology FOOD-INTAKE DISORDER Gastroenterology EATING-DISORDERS PSYCHOLOGICAL THERAPIES RANDOMIZED CONTROLLED-TRIAL GASTROINTESTINAL-SPECIFIC ANXIETY LOW-FODMAP DIET POLYOLS DIET VISCERAL SENSITIVITY Irritable Bowel Syndrome Diet Carbohydrate-Restricted Treatment Outcome Humans Pharmacology (medical) GAS-PRODUCTION COGNITIVE-BEHAVIORAL TREATMENT |
| Zdroj: | Alimentary Pharmacology & Therapeutics. 56(4):592-605 |
| ISSN: | 0269-2813 |
| Popis: | BACKGROUND: Irritable bowel syndrome (IBS) is a heterogeneous disorder of gut-brain interaction (DGBI) maintained by interacting biological, psychological, and social processes. Interestingly, there are two contrasting yet evidence-based treatment approaches for reducing IBS symptoms: exclusion diets such as those low in fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) and exposure-based cognitive-behavioural therapy (CBT). Exclusion diets recommend patients avoid foods thought to be symptom-inducing, whereas exposure-based CBT encourages patients to expose themselves to foods. AIMS: To address the paradox of conceptually opposite exclusion diets and exposure-based CBT for IBS. METHODS: In this conceptual review, we describe the rationale, practical implementation, evidence base and strengths and weaknesses of each treatment. We conducted up-to-date literature search concerning the low FODMAP diet and CBT, and performed a secondary analysis of a previously conducted trial to illustrate a key point in our review. RESULTS: The low FODMAP diet has demonstrated efficacy, but problems with adherence, nutritional compromise, and heightened gastrointestinal-specific anxiety raise caution. Exposure-based CBT has demonstrated efficacy with substantial evidence for gastrointestinal-specific anxiety as a key mechanism of action. Mediation analysis also showed that increased FODMAP intake mediated decreased symptom severity in exposure-based CBT. However, there is minimal evidence supporting which treatment "works best for whom" and how these approaches could be best integrated. CONCLUSIONS: Even though exclusion diets and exposure-based CBT are conceptually opposite, they each have proven efficacy. Clinicians should familiarise themselves with both treatments. Further research is needed on predictors, mechanisms and moderators of treatment outcomes. ispartof: Alimentary Pharmacology & Therapeutics vol:56 issue:4 pages:592-605 ispartof: location:England status: published |
| Databáze: | OpenAIRE |
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