ARE ADVERSE FOOD REACTIONS LINKED TO IRRITABLE-BOWEL-SYNDROME

Objective: We undertook to determine whether adverse food reactions pl ay a role in irritable bowel syndrome (IBS). Methods: A systematic rev iew of the literature using Medline (1980-1996), targeting IBS and adv erse food reactions, was performed. All clinical trials whereby dietar y exclusion was followed by food challenge were selected. Each study w as reviewed using a structured format to examine methodological issues and study outcomes. Results: Of the seven studies included, the posit ive response to an elimination diet ranged from 15% to 71%; double-bli nd placebo-controlled challenges identified problem foods in 6% to 58% of cases. Milk, wheat, and eggs were most frequently identified to ca use symptom exacerbation; of the foods identified the most common trai t was a high salicylate content. Foods high in amines were also identi fied. Studies of diarrhea-predominant IBS identified a higher percenta ge of adverse food reactions. However, all studies had major limitatio ns in their trial designs, including inadequate patient selection, app ropriateness of-and duration of-exclusion diets, and methods of food c hallenge. Conclusion: Whether adverse reactions to foods are a key fac tor in exacerbating IBS symptoms or whether dietary manipulation is a valid treatment option is unclear. Carefully designed controlled clini cal trials are now needed to specifically test the potential role of a dverse food reactions in diarrhea-predominant IBS. (C) 1998 by Am. Cel l. of Gastroenterology.