BMJ. 2024 Dec 16:387:e075777. doi: 10.1136/bmj-2023-075777.

Xiao Jing Wang ¹, Elyse Thakur ^2 3, Jordan Shapiro ⁴

Author information

¹Mayo Clinic Rochester, MN, USA Wang.xiao@mayo.edu.

²Atrium Health, Charlotte, NC, USA.

³Wake Forest University School of Medicine, Winston-Salem, NC, USA.

⁴Gentle GI, Houston, TX, USA.

Abstract

Irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction that impacts a significant portion of the population and is associated with substantial morbidity, reduced quality of life, and economic impact globally. The pathophysiology of IBS is complex and incompletely understood, and the heterogeneity of IBS is reflected in the variety of pharmaceutical and non-pharmaceutical therapies utilized for the management of IBS. Given limitations with pharmaceutical treatments, many patients with IBS seek non-pharmaceutical options. Several non-pharmaceutical treatments such as the low FODMAP diet and brain-gut behavior interventions such as gut directed hypnosis and cognitive behavioral therapy are now considered standard of care and are part of all major guidelines for the treatment of IBS. However, challenges with access to and optimal implementation of these therapies remain. This review focuses on the current evidence for common non-pharmaceutical treatments for IBS, including the latest advances in dietary and brain-gut behavioral care, in addition other complementary and integrative health practices and emerging therapies.