International guidelines support the use of diet based interventions as front line therapy from increased soluble fiber to more general dietary changes (eg, NICE guidance, low-FODMAP diet).
Guidelines overall support psychological and behavior based interventions with caveats to patient selection and differing suggestions for where these should be positioned.
Complementary and integrative health therapies including peppermint oil and traditional herbal based interventions are gaining acceptance with mixed recommendations in guidelines.
Microbiome based therapies are similar with overall limited evidence and mixed support from guidelines for probiotic use and consensus that FMT is not currently recommended for IBS treatment.
Continued areas of research and development blend traditional and modern techniques and include electroacupuncture, percutaneous vagal nerve stimulators, intestinal binders, vibrating capsules, digitally delivered psychotherapies, and virtual reality.
IBS is a heterogeneous disorder and many of the non-pharmaceutical approaches aim to provide personalized therapy for patients within a standardized framework, leading to challenges in standardizing and interpreting research for many of these interventions. Future research directions for many of these options should include identifying optimal protocols/dosages and treatment durations.
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