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Our understanding of the gut-brain axis in IBS is constantly evolving, with new eye-opening research further revealing this. While our role as dietitians is often diet-focused, it is critical to not over-simply the management of IBS, remembering that it is in fact a complex and multifactorial condition which is impacted by dysregulation in the gut-brain axis.

In this fascinating best practice update, Registered Nutritionist and IBS researcher Jessica Biesiekierski shares her knowledge and expertise on the complexities of the gut-brain dysregulation of IBS with reference to her research findings. She explains how visceral hypersensitivity increases individual responses to specific FODMAPs through abnormal complex gut-brain pathways, local neurological pathways, and visceral afferents. Jessica discusses how focusing on targeting the neurotransmitters and receptors involved in these gut-brain pathways, as well as addressing the psychological and psychosocial factors which contribute to visceral hypersensitivity (such through exposure CBT, hypnosis and psychological treatments) can have a profound impact on symptom reduction.

Although FODMAP exclusion diets are commonly used in IBS dietary management, exposure CBT focuses on introducing foods which were previously thought to induce symptoms, which can be useful in challenging perceptions around dietary triggers and calm the gut-brain axis. Further to this, focusing on exposure CBT, such as in collaboration with a psychologist, instead of recommending strict exclusion diets to patients, can also be potentially valuable in reducing the risk of, or preventing relapse of eating disorders, disordered eating and restrictive eating.

Overall, the management of IBS is complex, and it is crucial a thorough assessment is completed, including eating disorder screening, to ensure that the care provided is tailored to the individual and seeks to treat the underlying psychological triggers beyond the diet itself.

Summary:

• IBS is a multifactorial condition involving a complex interplay between the gut and the brain.
• Managing IBS includes targeting the neurotransmitters and receptors involved in gut-brain pathways, as well as addressing the psychological and psychosocial factors which contribute to visceral hypersensitivity.
• Integrated care models between a dietitian and a psychologist can ensure that psychological treatments such as exposure CBT and hypnosis are provided in addressing underlying gut-brain dysregulation and potential restrictive eating. The patient-practitioner relationship can also have a significant impact on patient outcomes.

Dr Jessica Biesiekierski is a Registered Nutritionist and Senior Lecturer with the Department of Nutrition, Dietetics and Food at Monash University. Jessica's research profile is recognised at an international level in the area of dietary effects on gastrointestinal physiology especially in disorders of gut-brain interactions.

Jessica is a past Post-doctoral Research Fellow with the Translational Research Centre for Gastrointestinal Disorders at KU Leuven in Belgium, where she explored gastric nutrient sensing and mechanistic effects of nutrients in gut-brain signalling. She completed her PhD with the Department of Gastroenterology at Monash University investigating the effects of gluten and carbohydrates as inducers of gastrointestinal symptoms in adults without coeliac disease.

Jessica has authored over 40 research articles with >4200 citations with some of her most notable achievements being awarded the international Rome Foundation’s Ken Heaton Award for the Most Cited Paper on Functional Gastrointestinal and Motility Disorders twice (2015 and 2013).

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