Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program or program for underweight.
Percutaneous electrical nerve field stimulation (PENFS): variant of electroacupuncture; stimulation is provided by three small needle patches stuck to the patient’s skin in the area of the auricle. According to the manufacturers, the “gut–brain axis” is to be influenced (evidence based on animal studies). The procedure may not be used in patients with hemophilia, pacemakers, or psoriasis vulgaris, according to the FDA.In a randomized trial of adolescents aged 11 to 18 years (50 subjects) who met Rome III criteria for irritable bowel syndrome, 52% of patients experienced at least a 30% decrease (versus 30% in the comparison group) in pain after 3 weeks using PENFS.
Nutritional medicine
Nutritional counseling based on nutritional analysis
Nutritional recommendations according to a mixed diet taking into account gender and age.
Observance of the following special nutritional recommendations:
Any foods that trigger discomfort should be avoided. Targeted avoidance of, for example, fat, carbohydrates (eg FODMAPs), legumes, cereals, salicylates, onions and alcohol, can lead to the elimination or significant improvement of the symptoms.
High fiber diet – It is particularly effective if the diet was previously low in fiber. Soluble fiber (gel formers such as psyllium (psyllium husks), ispaghula (Indian psyllium), plantago (plantain)) tends to improve symptoms better than insoluble fiber (eg, wheat bran and grain), especially in the context of obstipation-predominant IBS (irritable bowel syndrome with constipation). At the same time, attention must be paid to a high fluid intake.The use of soluble fiber also shows effect in irritable bowel syndrome of the diarrhea type (diarrhea) and pain type.
If necessary, probationary elimination diets (due toSuspicion of lactose or fructose intolerance), ie low-sugardiet taking into account the affected sugars; the same procedure applies to other food intolerances. Note: Longer-term elimination diets may be attempted only with confirmed evidence of individual food intolerances and under nutritional medical advice and supervision.
Reduce FODMAP-rich foods (low-FODMAP diet) – FODMAP is an abbreviation for “fermentable oligo-, di- and monosaccharides and polyols” and translates as “fermentable (fermentable) oligosaccharides (short-chain carbohydrates such as fructans and galactans), disaccharides (lactose), monosaccharides (fructose) and polyols” (= sugaralcohols such as maltitol, mannitol, sorbitol, xylitol, etc. ). FODMAPs are found, for example, in wheat, rye, garlic, onion, milk, honey, apple, pear, mushrooms, salicylate; fermentation produces gases and the osmotic effect (binding of water into the intestinal lumen) can have a laxative effect (see under “FODMAP diet for functional bowel disease”).The low-FODMAP diet under nutritional guidance may be a candidate for first-line therapy of IBS. The DGVS (German Society for Gastroenterology, Digestive and Metabolic Diseases) has clearly advocated the low-FODMAP diet (see below “FODMAP in functional bowel disease”).
Wheat/gluten-free diet in case of reproducible triggering or exacerbation of symptoms by cereal products after exclusion of celiac disease or wheat allergy (time-limited; subsequently targeted re-exposure, to be aimed at as a placebo-controlled provocation test [recommendation grade 0, consensus]; the same applies to symptoms caused by histamine-containing foods.
Intake of probiotics (probiotic cultures) [guidelines: level of evidence A, strength of recommendation ↑, strong consensus].
In a prospective study, 494 patients were divided into three groups (3:3:1; primary end point: adequate improvement in overall condition in at least three of four consecutive weeks, with follow-up surveys at three and 12 months): 12 weeks either
Individual hypnotherapy: response rate at three months in intention-to-treat analysis 40.8%/ at 2 months: 40.8%.
Group hypnotherapy: response rate after three months in intention-to-treat analysis 33.2%/ after 12 months: 49.5%.
Educational-supportive talk therapy (control; all six appointments each): response rate after three months in the intention-to-
Children with functional abdominal pain should be treated with cognitive behavioral training (CBT) or hypnosis. Symptom diaries and relaxation techniques (eg, yoga) may be helpful as part of the behavioral approach.
