Open Access Review Article

Dietary Interventions in Irritable Bowel

Syndrome: A Systematic Review of Clinical
Review began 09/09/2024
Outcomes, Microbiota Changes, and
Review ended 09/27/2024
Published 09/30/2024 Inflammatory Markers
© Copyright 2024 Muhammad Shams 1, Junaid Ahmed 2, Aqsa Umar 3, Abdur Rehman 4, Komal Sohail 5, Bushra Javed 6,
Shams et al. This is an open access article
distributed under the terms of the Creative
Raza Mustafa 7 , FNU Payal 8, Abdullah Shehryar 9 , Mustafa Khan 10
Commons Attribution License CC-BY 4.0.,
which permits unrestricted use, distribution, 1. Urology, Royal Bournemouth Hospital, Bournemouth, GBR 2. Internal Medicine, Chandka Medical College, Larkana,
and reproduction in any medium, provided
PAK 3. Internal Medicine, Mayo Hospital, Lahore, PAK 4. Surgery, Mayo Hospital, Lahore, PAK 5. Internal Medicine,
the original author and source are credited.
Sahiwal Medical College, Sahiwal, PAK 6. Internal Medicine, CMH Multan Institute of Medical Sciences, Multan, PAK 7.
DOI: 10.7759/cureus.70568
Internal Medicine, Sligo University Hospital, Sligo, IRL 8. Internal Medicine, Shaheed Mohtarma Benazir Bhutto
Medical University, Larkana, PAK 9. Internal Medicine, Allama Iqbal Medical College, Lahore, PAK 10. General Surgery,
Nishtar Medical University, Multan, PAK

Corresponding author: Mustafa Khan, [email protected]

Abstract
This systematic review synthesizes findings from 12 studies to evaluate the effectiveness of dietary
interventions in managing irritable bowel syndrome (IBS), with a focus on low-FODMAP (fermentable
oligosaccharides, disaccharides, monosaccharides, and polyols) diets, probiotics, and prebiotics. The review
rigorously follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)
guidelines and includes studies selected through comprehensive database searches. In adults diagnosed with
IBS, this review assesses how effective dietary interventions, specifically low-FODMAP diets, probiotics, and
prebiotics, are compared to standard management or placebo in improving clinical outcomes, modifying gut
microbiota composition, and reducing inflammatory markers. Our analysis reveals that low-FODMAP diets
consistently alleviate IBS symptoms and improve quality of life. However, the effectiveness of probiotics and
prebiotics varies, with outcomes dependent on specific strains and individual patient microbiota profiles.
The studies demonstrate significant improvements in gastrointestinal symptoms and microbiota
composition, highlighting the potential of dietary strategies to beneficially modify gut health. However, the
research points to the necessity of personalizing dietary approaches based on individual responses and
microbiota profiles to optimize treatment efficacy. The risk of bias was assessed using the Cochrane risk-of-
bias 2 tool for randomized controlled trials (RCTs) and the AMSTAR 2 tool for systematic reviews, with
varying degrees of bias across the studies. This review identifies gaps in the long-term efficacy of these
interventions and calls for more extensive trials to explore their sustained impacts. Our findings suggest
that dietary management should be integrated into routine IBS treatment protocols and emphasize the need
for further research to establish standardized dietary recommendations tailored to patient-specific
characteristics.

Categories: Other, Gastroenterology, Internal Medicine

Keywords: gastrointestinal disorders, nutrition therapy, gut health, dietary interventions, irritable bowel syndrome

Introduction And Background

Irritable bowel syndrome (IBS) remains one of the most common functional gastrointestinal disorders,
affecting approximately 10-15% of the global population, with a significant burden on both individual
quality of life and healthcare systems [1]. IBS is characterized by a complex constellation of symptoms,
including abdominal pain, bloating, and altered bowel habits. Its pathophysiology is multifactorial and not
completely understood, although it is thought to involve disruptions in the gut-brain axis, genetic
predispositions, abnormalities in gut motility, visceral hypersensitivity, immune dysregulation, and
psychosocial factors [2-4]. These diverse contributing factors make IBS a challenging condition to manage,
with treatments often targeting symptom relief rather than addressing the underlying causes.

Recent advances have highlighted the role of diet in managing IBS symptoms, particularly through the
modulation of gut microbiota, which has emerged as a significant factor in disease pathology and treatment
[5]. The gut microbiota, comprising trillions of microorganisms, plays a critical role in digestion, immune
function, and gut health. Alterations in the composition of the gut microbiota, or dysbiosis, have been linked
to IBS, sparking interest in therapeutic approaches that focus on restoring a healthy microbiota balance.

Among the dietary interventions, the low-FODMAP (fermentable oligosaccharides, disaccharides,

monosaccharides, and polyols) diet has gained attention for its ability to reduce symptoms by limiting the
intake of fermentable substrates that cause osmotic fermentation in the colon, thereby reducing gas
production and gastrointestinal distress [6]. Furthermore, probiotics and prebiotics, which aim to

How to cite this article

Shams M, Ahmed J, Umar A, et al. (September 30, 2024) Dietary Interventions in Irritable Bowel Syndrome: A Systematic Review of Clinical
Outcomes, Microbiota Changes, and Inflammatory Markers. Cureus 16(9): e70568. DOI 10.7759/cureus.70568
 manipulate the gut microbiota by introducing beneficial bacterial strains or promoting their growth, have
also been explored as potential treatments, with some studies showing improvements in symptoms and gut
health [7]. However, despite promising results, there is significant heterogeneity in the findings of these
studies, particularly regarding the efficacy of these interventions across different IBS subtypes (e.g., IBS with
diarrhea, IBS with constipation), and their long-term effects remain unclear [8].

The existing literature on IBS management highlights certain gaps in the evidence base. For example, while
several systematic reviews and meta-analyses have evaluated the effectiveness of the low-FODMAP diet,
probiotics, and prebiotics individually, there is still inconsistency in the results, largely due to differences in
study design, patient populations, and outcome measures. Moreover, these reviews often focus on short-
term outcomes, leaving uncertainties about the long-term impact of dietary interventions on gut microbiota
composition and inflammatory markers. There is also limited information on how individual microbiota
profiles may influence response to treatment, pointing to the need for more personalized approaches in
managing IBS. These gaps have motivated the need for a more comprehensive and detailed systematic
review that synthesizes the current evidence while addressing these inconsistencies.

The primary objective of this systematic review is to rigorously evaluate and synthesize current research
concerning the efficacy of dietary interventions, specifically low-FODMAP diets, probiotics, and prebiotics,
in the management of IBS. By examining changes in clinical outcomes, alterations in gut microbiota, and
modifications in inflammatory markers, this review aims to clarify the therapeutic potential of these dietary
approaches. Through a detailed analysis of randomized controlled trials (RCTs) and meta-analyses, this
review seeks to provide a critical assessment of the available evidence, identify gaps in the current
knowledge, and offer recommendations for future research directions. This will aid clinicians in tailoring
more effective, personalized dietary strategies for IBS patients, ultimately enhancing patient care and
management strategies in clinical settings.

Review
Materials and methods
Search Strategy

Our search strategy, developed in accordance with the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines [9], focused on identifying relevant studies that examine the efficacy of
dietary interventions for IBS. We conducted detailed searches across multiple databases, including PubMed,
MEDLINE, Embase, the Cochrane Library, and Scopus, covering literature published from the inception of
each database up to July 2024. The search strategy for each database was specifically tailored to its search
capabilities. Keywords and Medical Subject Headings (MeSH) terms used in our search included "irritable
bowel syndrome," "IBS," "low-FODMAP diet," "probiotics," "prebiotics," and "dietary management of IBS."
Boolean operators ('AND', 'OR') were employed to combine these terms effectively. Filters were applied to
limit results to studies published in English and focused on adult populations. The search strategy for
PubMed, for instance, was as follows: ("irritable bowel syndrome"[MeSH Terms] OR "IBS") AND ("low
FODMAP" OR "probiotics" OR "prebiotics") AND ("clinical trial" OR "randomized controlled trial"). Similar
strategies were adapted for MEDLINE, Embase, Cochrane Library, and Scopus to ensure a comprehensive
retrieval of relevant data across the databases.

To ensure the inclusion of the most relevant and recent data, we also reviewed the reference lists of all
retrieved articles, checked clinical trial registries, and explored relevant conference proceedings for
unpublished studies. This approach aimed to capture both published and grey literature, broadening the
scope of our review and enhancing the robustness of our findings. Our search was limited to studies
published in English and included randomized controlled trials, cohort studies, and meta-analyses to ensure
a high standard of evidence in our systematic review.

Eligibility Criteria

To ensure the rigor and specificity of our systematic review, we established clear eligibility criteria based on
the PICO framework (Population, Intervention, Comparison, Outcome). Our review focuses on peer-
reviewed research articles that investigate dietary interventions for managing IBS. Specifically, we include
clinical trials, RCTs, cohort studies, and meta-analyses that evaluate the effectiveness of interventions such
as the low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet,
probiotics, and prebiotics in adults diagnosed with IBS (Population). These studies must provide detailed
data on clinical outcomes (Outcome), including symptom management, changes in gut microbiota
composition, and inflammatory markers, with comparisons to standard management or placebo where
applicable (Comparison). We target studies conducted on adult populations diagnosed according to
recognized criteria, such as the Rome III or IV criteria, which are standardized guidelines used to diagnose
IBS based on specific symptom patterns. Articles published in English from the inception of the databases up
to July 2024 are included to capture the most recent and comprehensive findings.

The exclusion criteria were carefully defined to refine the scope of our review. We excluded studies that focus

2024 Shams et al. Cureus 16(9): e70568. DOI 10.7759/cureus.70568 2 of 9

 on pediatric populations, as the response to dietary interventions can differ significantly between children
and adults. Studies that do not explicitly assess the outcomes relevant to our review's objectives, such as IBS
symptom relief, microbiota composition changes, and inflammatory marker alterations, are omitted. In
addition, non-peer-reviewed articles, letters, editorials, and conference abstracts are excluded to maintain a
high standard of evidence. Lastly, studies published in languages other than English are not considered to
avoid potential inconsistencies from translation errors and ensure the precision and reliability of the data
synthesized in our systematic review.

Data Extraction

For our systematic review of dietary interventions in managing IBS, we followed a structured data extraction
process. Initially, articles were screened by two independent reviewers based on titles and abstracts to assess
relevance. Articles were categorized as "relevant," "not relevant," or "potentially relevant." Full-text reviews
were then conducted for "potentially relevant" articles to confirm eligibility according to our inclusion and
exclusion criteria.

The data extraction itself was performed using a standardized form developed in Microsoft Excel to ensure
uniformity and accuracy across the review process. Each selected article was meticulously analyzed by the
reviewers, who independently extracted data on key variables such as study author(s), publication year,
study design, sample size, intervention details, outcome measures, main results, and limitations.
Discrepancies between reviewers were resolved through discussion or, if necessary, arbitration by a third
reviewer. This methodical approach ensured that all relevant data were accurately captured, allowing for a
robust synthesis and analysis aligned with the review’s objectives.

Data Analysis and Synthesis

Due to the heterogeneous nature of the studies examined regarding dietary interventions for IBS, a meta-
analysis was deemed inappropriate. Instead, we adopted a qualitative synthesis approach to analyze the
data, focusing on integrating and interpreting findings across different studies. This narrative synthesis
allowed us to explore the effects of various dietary strategies on IBS symptoms, gut microbiota, and
inflammatory markers comprehensively. By categorizing outcomes and identifying recurring themes and
discrepancies among the studies, we provided a nuanced understanding of the efficacy of interventions like
low-FODMAP diets, probiotics, and prebiotics. This method not only highlighted the complexities of dietary
effects on IBS but also pinpointed research gaps and potential areas for future investigation.

Results
Study Selection Process

The study selection process for our systematic review was meticulously organized to ensure the inclusion of
comprehensive and relevant studies. Initially, we identified a total of 214 records from a variety of
databases, including PubMed (50 records), MEDLINE (40 records), Embase (60 records), the Cochrane Library
(34 records), and Scopus (30 records). After removing 16 duplicates, we screened 198 articles based on their
titles and abstracts. This screening led to the exclusion of 79 records that did not meet preliminary inclusion
criteria, such as relevance to dietary interventions in IBS or providing sufficient detail in the abstracts. We
then sought to retrieve 119 full-text articles for a more detailed evaluation, of which 21 were not available.
The remaining 98 reports underwent a thorough review against our specified inclusion and exclusion
criteria. This phase resulted in the exclusion of an additional 86 reports, primarily due to their failure to
directly address the research questions or the lack of necessary data. Ultimately, 12 studies were deemed
eligible and included in the review, forming the basis for our comprehensive analysis of dietary
interventions in the management of IBS. A summary of the study selection process is given in Figure 1.

2024 Shams et al. Cureus 16(9): e70568. DOI 10.7759/cureus.70568 3 of 9

 FIGURE 1: The PRISMA flowchart representing the study selection
process.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Characteristics of the Selected Studies

The studies selected for our systematic review span a range of methodologies and focus areas within the
scope of dietary interventions for IBS. These investigations encompass RCTs, double-blind crossover trials,
and systematic reviews with meta-analysis, highlighting a robust approach to exploring the efficacy of
dietary strategies in IBS management. The interventions examined include low-FODMAP (fermentable
oligosaccharides, disaccharides, monosaccharides, and polyols) diets, probiotics, prebiotics, and their
impact on different populations, including both adult and pediatric patients, across various IBS subtypes.
Key outcomes from these studies consistently indicate improvements in IBS symptoms such as reduced
severity and enhanced quality of life, alongside beneficial changes in gut microbiota. The evidence supports
the short-term efficacy of low-FODMAP diets in reducing gastrointestinal discomfort and suggests variable
effectiveness of probiotics dependent on strain specificity. The findings collectively underscore the
potential of personalized dietary management in IBS treatment, emphasizing the importance of tailoring
interventions to individual dietary responses and microbiota profiles to optimize therapeutic outcomes. A
summary of the selected studies is given in Table 1.

Study Risk of bias

Authors Purpose Methods Results Conclusions
year (method employed)

Anne- Investigate low- Low-FODMAP diet is Low risk of bias

Sophie van FODMAP diet effects on Systematic search and Reduced IBS severity effective but requires (Cochrane Risk of

Lanen et al. 2021 IBS symptoms, life meta-analysis with and improved quality of more research on long- Bias Tool for
[10] quality, nutrition, and random effects models life term effects. Systematic

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 gut microbiome Reviews)

Assess the efficacy and

Low risk of bias
safety of a probiotic Double-blind, Significant improvement Probiotics are effective in
Ruggiero (Cochrane Risk of
mixture in celiac randomized, placebo- in IBS symptoms and improving IBS-type
Francavilla 2019 Bias 2 (RoB 2) Tool
patients with IBS controlled multicenter increased beneficial gut symptoms in celiac
et al. [11] for Randomized
symptoms on a gluten- study over six weeks bacteria disease patients.
Controlled Trials)
free diet

Review of trials and

Promising results in Effective in reducing Moderate risk of bias
Muhammad Evaluate low-FODMAP studies on low-
symptom reduction but symptoms; impacts on (AMSTAR 2 Tool for
Ali Khan et 2015 diet as a treatment FODMAP diet's
significant changes in gut health need further Systematic
al. [12] strategy for IBS mechanism and
gut microbiota study. Reviews)
efficacy

Assess current Probiotics and low- Low risk of bias

Mixed results on
Soo Liang evidence on probiotics, Systematic review of FODMAP diet are (Cochrane Risk of
probiotics and prebiotics;
Ooi et al. 2019 prebiotics, and low- reviews and meta- effective under Bias Tool for
low-FODMAP diet
[13] FODMAP diet efficacy analyses supervision; prebiotics Systematic
improves symptoms
in IBS treatment lack clinical evidence. Reviews)

Meta-analyze the low- Screening of Low risk of bias

Improvements in LFD shows short-term
Dania FODMAP diet's effects databases and (Cochrane Risk of
symptoms and quality of efficacy and safety; long-
Schumann 2018 on IBS symptom inclusion of RCTs Bias Tool for
life; reduction in certain term effects require
et al. [14] severity, quality of life, comparing LFD to Systematic
gut bacteria further investigation.
and safety other diets Reviews)

Study of 164 IBS

Moderate risk of bias
patients from a No sex differences in No general sex
Magdy El- Investigate sex (Cochrane Risk of
previous RCT, overall response; differences, but notable
Salhy et al. 2021 differences in response Bias 2 (RoB 2) Tool
analyzing severity, females with IBS-D had female responses in IBS-
[15] to FMT in IBS patients for Randomized
quality of life, and better outcomes. D.
Controlled Trials)
microbial changes

Randomization of 108 Low risk of bias

Compare low-FODMAP LFD and TDA are both
Yawen patients to diets, Similar improvement (Cochrane Risk of
diet and traditional effective; LFD offers
Zhang et al. 2021 assessment of rates; earlier symptom Bias 2 (RoB 2) Tool
dietary advice in quicker symptomatic
[16] symptoms, and relief with low-FODMAP for Randomized
Chinese IBS-D patients relief.
microbiota changes Controlled Trials)

Study low FODMAP- A six-week clinical trial LF-GFD improves Moderate risk of bias
Kaveh gluten-free diet's impact with 42 IBS patients, Significant symptom symptoms and gut (Cochrane Risk of
Naseri et 2021 on IBS symptoms, using symptom improvement and health; further studies Bias 2 (RoB 2) Tool
al. [17] microbiota diversity, and scoring and microbiota microbiota normalization are needed for long-term for Randomized
fecal calprotectin analysis efficacy. Controlled Trials)

Evaluate low-FODMAP Double-blind, Less abdominal pain Effective in reducing Moderate risk of bias
BP diet efficacy in crossover trial with with low-FODMAP; childhood IBS (Cochrane Risk of
Chumpitazi 2015 childhood IBS and its dietary intervention, specific microbiome symptoms; microbiome Bias 2 (RoB 2) Tool
et al. [18] association with gut microbiome, and changes linked to diet biomarkers predict for Randomized
microbiome symptom analysis response response. Controlled Trials)

A nine-week study
Compare the effects of Low-FODMAP alleviates Moderate risk of bias
with supplement Improvement with low-
low-FODMAP and high- symptoms and impacts (Cochrane Risk of
T N Hustoft intervention and FODMAP; specific
2017 FOS diets on IBS gut microbiota; FOS has Bias 2 (RoB 2) Tool
et al. [19] comprehensive bacterial and cytokine
symptoms and limited effect on for Randomized
symptom and changes noted
microbiota cytokines or microbiota. Controlled Trials)
microbiota profiling

Probiotics provide
Assess the efficacy of Moderate risk of bias
María Ortiz- Meta-analysis of trials Specific probiotics symptom relief; effects
various probiotic (AMSTAR 2 Tool for
Lucas et al. 2013 comparing probiotics improve pain, distension, vary by species and
species on IBS Systematic
[20] to placebo and flatulence scores need further
symptoms Reviews)
investigation.

Examine the efficacy of A 12-week controlled Increased bifidobacteria Moderate risk of bias
a trans- clinical trial with and improvements in Prebiotic stimulates (Cochrane Risk of
D B A Silk galactooligosaccharide dosage variation, stool consistency, beneficial bacteria and Bias 2 (RoB 2) Tool
2009
et al. [21] prebiotic on IBS monitoring symptoms, flatulence, bloating, and effectively alleviates IBS for Randomized
symptoms and gut and microbiota symptoms.

2024 Shams et al. Cureus 16(9): e70568. DOI 10.7759/cureus.70568 5 of 9

 microflora changes. psychological symptoms Controlled Trials)

TABLE 1: A summary of the included studies in this systematic review.

IBS: irritable bowel syndrome; RCT: randomized controlled trial; FMT: fecal microbiota transplantation; IBS-D: irritable bowel syndrome with diarrhea;
FODMAP: fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; LFD: low-FODMAP diet; TDA: traditional dietary advice; LF-GFD:
low-FODMAP-gluten-free diet; FOS: fructooligosaccharide

Discussion
Our systematic review rigorously analyzed the efficacy of various dietary interventions in the management
of IBS, encompassing a total of 12 foundational studies. Key findings consistently highlighted the significant
impact of low-FODMAP diets, probiotics, and prebiotics on alleviating IBS symptoms, improving the quality
of life, and modifying gut microbiota composition. Specifically, low-FODMAP diets were frequently
associated with reductions in gastrointestinal discomfort and improvements in overall well-being [22].
Probiotics and prebiotics, meanwhile, demonstrated positive effects on gut health, contributing to increased
levels of beneficial bacteria and decreased inflammation, although the results varied based on specific
strains and formulations [23]. These findings address our initial research hypotheses positing that tailored
dietary strategies can significantly influence clinical outcomes in IBS patients, providing a clear link
between diet modification and symptomatic relief.

This comprehensive evaluation highlights the complexity and heterogeneity of dietary responses in IBS,
suggesting that while dietary interventions hold promise, their effectiveness is influenced by individual
patient characteristics including microbiota composition and dietary adherence [24]. The analysis not only
confirms the potential of these dietary approaches as part of a broader IBS management strategy but also
highlights the necessity for personalized dietary recommendations to maximize therapeutic outcomes. This
synthesis of data provides a pivotal foundation for further discussion on the integration of these findings
into clinical practice and ongoing research [25].

The findings of our systematic review are largely consistent with existing literature that underscores the
benefits of dietary interventions in managing IBS. For instance, several studies within our review reported
significant improvements in IBS symptoms with low-FODMAP diets, aligning with findings from prior
meta-analyses such as Marsh et al. (2016) [26], which also documented a reduction in symptom severity
among IBS patients adhering to low-FODMAP diets. However, while our review highlighted some variability
in the effectiveness of probiotics, this contrasts with more definitive positive outcomes noted in studies [27],
which found consistent benefits of specific probiotics strains for overall IBS symptom management. These
discrepancies may be attributed to differences in study designs, populations, probiotic strains used, and
duration of treatment across studies.

Furthermore, our review extends the existing knowledge base by examining the interplay between diet, gut
microbiota, and inflammatory markers in IBS, an area that has received less attention in earlier reviews.
While we noted improvements in gut microbiota composition and inflammatory markers in response to
dietary interventions, these results were not uniformly observed across all included studies, suggesting a
complex interaction influenced by individual patient microbiomes and dietary compliance. This complexity
is echoed in the work of Chumpitazi et al. [18], which found that responses to dietary interventions could
vary significantly based on baseline microbiota profiles, pointing to the need for personalized dietary
management strategies in IBS treatment. Such findings indicate a move toward more individualized
therapeutic approaches in the gastroenterological field, highlighting the importance of tailoring treatments
to the specific biological and clinical profiles of IBS patients [28].

The outcomes of our systematic review have significant theoretical implications for the understanding and
management of IBS. By demonstrating the efficacy of dietary interventions such as low-FODMAP diets,
probiotics, and prebiotics in modulating symptoms and altering gut microbiota, our findings reinforce and
expand the gut-brain axis theory in IBS. This theory posits that a bidirectional communication exists
between the gastrointestinal tract and the brain, influencing both physical and psychological aspects of the
disease [29]. Our analysis supports this model by showing how dietary modifications can lead to changes in
gut microbiota composition and subsequent symptom alleviation, possibly through mechanisms involving
short-chain fatty acids and inflammatory cytokines. These insights contribute to a deeper understanding of
the pathophysiology of IBS and suggest that dietary management could play a crucial role in breaking the
cycle of dysbiosis and inflammation thought to exacerbate the condition. Consequently, our review not only
aligns with existing gastrointestinal models but also enhances them by highlighting the integral role of diet
and microbial health in managing chronic gastrointestinal disorders [30].

The practical implications of our systematic review are profound, offering clear guidance for clinicians and
dietitians managing IBS. The demonstrated efficacy of low-FODMAP diets, probiotics, and prebiotics in
alleviating IBS symptoms provides a strong basis for these dietary strategies to be integrated into standard

2024 Shams et al. Cureus 16(9): e70568. DOI 10.7759/cureus.70568 6 of 9

 IBS management protocols. Clinicians are encouraged to consider individual dietary counseling as part of
the treatment plan, which includes assessing patients' dietary habits, symptom triggers, and tolerance to
specific foods. Furthermore, given the variability in response to probiotics, healthcare providers should
consider personalized approaches, possibly guided by gut microbiota profiling, to identify the most
beneficial probiotic strains for individual patients. For policymakers, these findings highlight the
importance of supporting and funding dietary management programs as a cost-effective approach to reduce
the burden of IBS on healthcare systems. In addition, the connection between diet, gut microbiota, and IBS
symptoms emphasized in our review suggests that further research should focus on longitudinal studies to
explore the long-term effects of dietary interventions and their impact on life quality among IBS patients.
This would aid in refining dietary recommendations and tailoring more effective, patient-specific
therapeutic options [31,32].

Our systematic review is underpinned by several methodological strengths that enhance the credibility and
reliability of our findings. Foremost, the adherence to the PRISMA guidelines ensured a structured and
transparent approach, facilitating reproducibility and rigor in our review process. The comprehensive search
strategy across multiple databases, including PubMed, MEDLINE, and Embase, allowed for an extensive
collection of relevant studies, minimizing the risk of publication bias. In addition, the inclusion of diverse
dietary interventions such as low-FODMAP diets, probiotics, and prebiotics provided a holistic view of the
available treatments for IBS, enhancing the applicability of our conclusions to various patient populations.

However, our review is not without limitations. The heterogeneity in study designs, populations, and
outcome measures among the included studies posed challenges in drawing uniform conclusions, which may
limit the generalizability of our findings. Furthermore, the restriction to articles published in English could
have omitted relevant studies conducted in other languages, potentially introducing language bias. The
exclusion of gray literature and unpublished studies might also limit the comprehensiveness of our analysis.
Future research should aim to include a broader range of studies, possibly through meta-analyses that can
quantify the effects more precisely and explore the relationships between diet, microbiota changes, and IBS
symptoms in different subpopulations and settings.

Building upon the insights gained from our systematic review, several areas warrant further investigation to
deepen the understanding of dietary interventions in IBS. Future research should focus on longitudinal
studies to explore the long-term efficacy and safety of low-FODMAP diets, probiotics, and prebiotics. There
is also a critical need for larger, multicentric randomized controlled trials to assess the variability in
individual responses to these dietary interventions, potentially exploring genetic, environmental, or
microbiome-related factors that influence treatment outcomes. In addition, studies should aim to integrate
advanced technologies such as metagenomic sequencing to provide more detailed insights into how these
dietary strategies alter gut microbiota composition and function. Addressing these gaps will not only
enhance our understanding of the mechanisms underlying the dietary management of IBS but also improve
the personalization of treatment strategies, ultimately leading to better patient outcomes [33].

Conclusions
Our systematic review underscores the significant potential of dietary interventions, namely, low-FODMAP
diets, probiotics, and prebiotics, as effective strategies for managing IBS. These approaches not only
alleviate symptoms but also contribute to understanding the complex interactions within the gut microbiota
and its influence on the condition. By integrating these dietary strategies into routine clinical practice,
healthcare providers can offer more personalized and effective treatment plans. Moreover, our findings
highlight the importance of dietary management as a cornerstone of IBS treatment, which, when
appropriately tailored, can significantly enhance patient quality of life. We encourage the scientific and
medical communities to continue exploring the intricate dynamics between diet and gut health, pushing the
boundaries of what is currently known and expanding the therapeutic possibilities for IBS patients
worldwide.

Additional Information
Author Contributions
All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the
work.

Acquisition, analysis, or interpretation of data: Mustafa Khan, Komal Sohail, Raza Mustafa, Junaid
Ahmed, Muhammad Shams, Abdullah Shehryar, Aqsa Umar

Drafting of the manuscript: Mustafa Khan, Junaid Ahmed, Muhammad Shams, Abdur Rehman, Aqsa Umar

Critical review of the manuscript for important intellectual content: Komal Sohail, Raza Mustafa,
Bushra Javed, Junaid Ahmed, Muhammad Shams, Abdullah Shehryar, Aqsa Umar, FNU Payal

Concept and design: Bushra Javed, Junaid Ahmed, Muhammad Shams, Abdur Rehman, Aqsa Umar, FNU

2024 Shams et al. Cureus 16(9): e70568. DOI 10.7759/cureus.70568 7 of 9

 Payal

Supervision: Muhammad Shams

Disclosures
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the
following: Payment/services info: All authors have declared that no financial support was received from
any organization for the submitted work. Financial relationships: All authors have declared that they have
no financial relationships at present or within the previous three years with any organizations that might
have an interest in the submitted work. Other relationships: All authors have declared that there are no
other relationships or activities that could appear to have influenced the submitted work.

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