Abstract
Background & Aims
Functional Bowel Disorders (FBD) are clinically diagnosable conditions impacting the mid to lower gastrointestinal tract. Fibre manipulation (through amount or type) is commonly employed as a first-line treatment for symptom management. This systematic review will investigate the impact of fibre manipulation on symptom management and quality of life in adults diagnosed with FBD.
Methods
Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Central) were systematically searched from January 2013 to December 2024. Studies were included if they reported Randomised Controlled Trials (RCTs) examining the impact of fibre manipulation in adults (≥ 18 years) with FBD. The primary outcome was symptom management, and secondary outcome was Quality of Life (QoL). Study quality was assessed using the Cochrane risk of bias tool 2. Data were narratively synthesised.
Results
Searches identified 8864 records; 5167 were screened against the eligibility criteria, and 47 records were assessed at full-text review. Ten studies reporting eight parallel and two crossover RCTs evaluating differing fibre supplements and doses for people with various types of FBD were included. Intervention length ranged from one to eight weeks, and the number of participants ranged from 11 to 250. The reported results varied. Seven studies reported significant improvements in symptom severity, and one study reported significant worsening of symptoms when compared to controls. The results indicated that fibre supplementation with agave fructans improved constipation but worsened flatulence, acacia fibre improved stool frequency, psyllium improved stool consistency, nopal fibre improved symptom severity, vege-powder improved stool hardness and amount, incomplete evacuation, straining and evacuation frequency, pectin powder improved abdominal pain, bloating, stool consistency and symptom severity, and a combination of sugarcane bagasse and resistant starch improved flatulence. One study reported significant worsening in QoL in the intervention group when compared to the placebo control group.
Conclusions
This review concluded that fibre supplementation may be an effective treatment to improve symptom management for patients with FBD, though high heterogeneity precluded meta-analysis. Two studies were assessed as low risk of bias, seven had some concerns, and one was assessed as high risk of bias. The included studies reported short-term interventions for small groups of participants. Further research with greater numbers of participants with FBD that evaluate interventions for longer time periods are warranted.
Functional Bowel Disorders (FBD) are clinically diagnosable conditions impacting the mid to lower gastrointestinal tract. Fibre manipulation (through amount or type) is commonly employed as a first-line treatment for symptom management. This systematic review will investigate the impact of fibre manipulation on symptom management and quality of life in adults diagnosed with FBD.
Methods
Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Central) were systematically searched from January 2013 to December 2024. Studies were included if they reported Randomised Controlled Trials (RCTs) examining the impact of fibre manipulation in adults (≥ 18 years) with FBD. The primary outcome was symptom management, and secondary outcome was Quality of Life (QoL). Study quality was assessed using the Cochrane risk of bias tool 2. Data were narratively synthesised.
Results
Searches identified 8864 records; 5167 were screened against the eligibility criteria, and 47 records were assessed at full-text review. Ten studies reporting eight parallel and two crossover RCTs evaluating differing fibre supplements and doses for people with various types of FBD were included. Intervention length ranged from one to eight weeks, and the number of participants ranged from 11 to 250. The reported results varied. Seven studies reported significant improvements in symptom severity, and one study reported significant worsening of symptoms when compared to controls. The results indicated that fibre supplementation with agave fructans improved constipation but worsened flatulence, acacia fibre improved stool frequency, psyllium improved stool consistency, nopal fibre improved symptom severity, vege-powder improved stool hardness and amount, incomplete evacuation, straining and evacuation frequency, pectin powder improved abdominal pain, bloating, stool consistency and symptom severity, and a combination of sugarcane bagasse and resistant starch improved flatulence. One study reported significant worsening in QoL in the intervention group when compared to the placebo control group.
Conclusions
This review concluded that fibre supplementation may be an effective treatment to improve symptom management for patients with FBD, though high heterogeneity precluded meta-analysis. Two studies were assessed as low risk of bias, seven had some concerns, and one was assessed as high risk of bias. The included studies reported short-term interventions for small groups of participants. Further research with greater numbers of participants with FBD that evaluate interventions for longer time periods are warranted.
| Original language | English |
|---|---|
| Article number | 102896 |
| Pages (from-to) | 1-57 |
| Number of pages | 57 |
| Journal | Clinical Nutrition ESPEN |
| DOIs | |
| Publication status | E-pub ahead of print - 10 Jan 2026 |