Are adverse food reactions linked to irritable bowel syndrome?

Am J Gastroenterol. 1998 Nov;93(11):2184-90. doi: 10.1111/j.1572-0241.1998.00531.x.


Objective: We undertook to determine whether adverse food reactions play a role in irritable bowel syndrome (IBS).

Methods: A systematic review of the literature using Medline (1980-1996), targeting IBS and adverse food reactions, was performed. All clinical trials whereby dietary exclusion was followed by food challenge were selected. Each study was reviewed using a structured format to examine methodological issues and study outcomes.

Results: Of the seven studies included, the positive response to an elimination diet ranged from 15% to 71%; double-blind placebo-controlled challenges identified problem foods in 6% to 58% of cases. Milk, wheat, and eggs were most frequently identified to cause symptom exacerbation; of the foods identified the most common trait was a high salicylate content. Foods high in amines were also identified. Studies of diarrhea-predominant IBS identified a higher percentage of adverse food reactions. However, all studies had major limitations in their trial designs, including inadequate patient selection, appropriateness of--and duration of--exclusion diets, and methods of food challenge.

Conclusion: Whether adverse reactions to foods are a key factor in exacerbating IBS symptoms or whether dietary manipulation is a valid treatment option is unclear. Carefully designed controlled clinical trials are now needed to specifically test the potential role of adverse food reactions in diarrhea-predominant IBS.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Clinical Trials as Topic
  • Colonic Diseases, Functional / etiology*
  • Double-Blind Method
  • Food / adverse effects*
  • Food Hypersensitivity / complications*
  • Humans
  • Research Design