Behavioral and Diet Therapies in Integrated Care for Patients with Irritable Bowel Syndrome

Gastroenterology. 2020 Oct 19;S0016-5085(20)35281-1.doi: 10.1053/j.gastro.2020.06.099. Online ahead of print.

W D Chey 1, L Keefer 2, K Whelan 3, P R Gibson 4


Author information

  • 1Division of Gastroenterology, Michigan Medicine, Ann Arbor, MI, USA. Electronic address: wchey@umich.edu.
  • 2Mt Sinai Medical Center, NYC, NY, USA.
  • 3King's College London, Department of Nutritional Sciences, London, UK.
  • 4Monash University, Melbourne, AU.


Irritable bowel syndrome (IBS) is a common, symptom-based condition that has negative effects on quality of life and costs healthcare systems billions of dollars each year. Until recently, management of IBS has focused on over the counter and prescription medications that reduce symptoms in fewer than half of patients. Patients have increasingly sought natural solutions for their IBS symptoms. However, behavioral techniques and dietary modification can be effective in treatment of IBS. Behavioral interventions include gastrointestinal-focused cognitive behavioral therapy and gut-directed hypnotherapy, to modify interactions between the gut and the brain. In this pathway, benign sensations from the gut induce maladaptive cognitive or affective processes that amplify symptom perception. Symptoms occur in response to cognitive and affective factors that trigger fear of symptoms or lack of acceptance of disease, or from stressors in the external environment. Among the many dietary interventions used to treat patients with IBS, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) is the most commonly recommended by healthcare providers and has the most evidence for efficacy. Patient with IBS who choose to follow the low-FODMAP diet should be aware of its 3 phases: restriction, reintroduction, and personalization. Management of IBS should include an integrated care model, in which behavioral interventions, dietary modification, and medications are considered as equal partners. This approach offers the greatest likelihood for success in management of patients with IBS.

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