MANAGEMENT OF PATIENTS WITH FOOD INTOLERANCE IN IRRITABLE-BOWEL-SYNDROME - THE DEVELOPMENT AND USE OF AN EXCLUSION DIET

Food intolerance is an important cause of abdominal symptoms. As no ob jective tests are available to identify the foods concerned, diets are essential for the management of these patients. The fewer foods allow ed in the diet, the greater is the chance of success. Our original stu dies of 182 patients between 1979 and 1982, using a diet of lamb, rice and pears, had resulted in a 67% success rate. The foods most commonl y involved were wheat (60%), cows' milk (44%) and corn (44%). A less r estrictive exclusion diet was developed from the results of this work, avoiding all those foods to which 20% or more of the patients had bee n intolerant. Of 253 patients (79%), 200 were able to complete 2 weeks on this diet and 100 (50%) were successful in controlling their sympt oms. The exclusion diet was modified in the light of this experience a nd in a subsequent study of 129 patients, 96 (75%) were able to comply for 2 weeks, but only 39 (41%) improved on the basic diet. However, e xamination of the food diaries of these patients enabled the identific ation of less frequent food intolerances in 21 (22%) giving an overall success rate of 60 (63%). In this way, equally good results can be ob tained using a nutritionally adequate exclusion diet and avoiding the difficulties of following a more rigorous elimination regime.