Dietetic management of irritable bowel syndrome: A national survey of dietary approaches and decision-making factors

• Published in: Clinical medicine (London, England) England), 2024-04, Vol.24, p.100132, Article 100132
• Main Authors: Dhali, Arkadeep, Trott, Nick, Shiha, Mohamed G., Aziz, Imran, Shaw, Christian C., Buckle, Rachel L., Sanders, David S.
• Format: Article
• Language: English
• ISSN: 1470-2118
• DOI: 10.1016/j.clinme.2024.100132

There has been a growing emphasis on dietary therapies for irritable bowel syndrome (IBS). Furthermore, there has been a growing evidence base for the FODMAP diet, gluten-free diet (GFD), and lactose-free diet. This study examines the dietary approaches employed, the factors influencing dietetic decision-making for IBS interventions, and the patient education methods utilised by registered dietitians, nutritionists, and student dietitians in diverse healthcare settings. Participants, including registered dietitians and nutritionists, were recruited from diverse healthcare settings at the point of registration for the 4th Sheffield Dietetic Gastroenterology Symposium. A 15-question online survey investigated the practices of dietitians and nutritionists in managing IBS patients, covering dietary approaches, decision-making factors, and patient education. The evidence base for different dietary interventions was provided and a follow-up survey assessed symposium attendees' views on current IBS dietary practices. Out of 731 respondents, primarily registered dietitians (93%) and females (93.4%), 53.6% spent 10-50% of clinic time on IBS. Respondents noted that GFD (34%), low Lactose (32%), and TDA (18%) were the most frequently used dietary interventions that patients try before seeking professional advice. At follow-up the survey (n = 186) respondents still ranked TDA as their first-line dietary intervention for IBS (87%). However, the use of low lactose and GFD significantly increased from 11% to 62% (p < 0.0001) and from 5% to 23% (p < 0.0001), respectively (Fig. 1). The factors influencing the decision to recommend a specific dietary therapy have also changed after attending the symposium, with greater emphasis on patient acceptability (pre-symposium 94%, post-symposium- 98%) and the time needed to provide counseling (pre-symposium 79%, post-symposium- 98%) (Fig. 2). TDA remains the choice of diet for dieticians. After our educational event, the use of low-lactose and gluten-free significantly increased. Factors influencing recommendations shifted towards patient acceptability and counseling time. A longer-term follow-up could provide insights into the sustainability of the reported changes in practice.