ReviewAlimentary pharmacology & therapeutics2022
Review article: exclude or expose? The paradox of conceptually opposite treatments for irritable bowel syndrome.
Review in Alimentary pharmacology & therapeutics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06940596 (Exclude or Expose in Irritable Bowel Syndrome), which is not on this map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Exclude or Expose in Irritable Bowel Syndrome: What Works for Whom, and How? A Randomized Controlled Trial of Internet-Delivered FODMAP Diet Versus Exposure-Based Cognitive Behavioral Therapy
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A Clinical Practice Update for the Management of Patients With Disorders of Gut-Brain Interaction and Altered Food Intake Behavior.Neurogastroenterology and motility · 2026Guideline
- Impact of Acute and Sub-Acute Gluten Exposure on Gastrointestinal Symptoms and Psychological Responses in Non-Coeliac Gluten Sensitivity: A Randomised Crossover Study.United European gastroenterology journal · 2025Trial
- Internet-delivered cognitive behavioral therapy and FODMAP diet for adults with irritable bowel syndrome: A four-arm randomized controlled trial.Internet interventions · 2026Article
- Disorders of Gut-Brain Interaction in Eating Disorders: A Review of Management Approaches.Current psychiatry reports · 2026Review
- Navigation, Adoption, and Use of Digital Health Technologies for Irritable Bowel Syndrome Self-Management: Focus Group Study of Patient Experience and Decision-Making.JMIR human factors · 2026Article
- The Prevalence and Burden of Avoidant/Restrictive Food Intake Disorder Symptoms in Adults With Disorders of Gut-Brain Interaction: A Population-Based Study.Gastroenterology · 2026Article
- Diet Stacking - An Expanding Challenge for Gastroenterologists and Dietitians in Managing Chronic Gastrointestinal Disorders.JGH open : an open access journal of gastroenterology and hepatology · 2025Review
- Predicting response to the low FODMAP diet in irritable bowel syndrome: Current evidence and clinical considerations.Asia Pacific journal of clinical nutrition · 2025Review
- Coffee, Alcohol, and Artificial Sweeteners Have Temporal Associations with Gastrointestinal Symptoms.Digestive diseases and sciences · 2024Article
- Development of a brief cognitive-behavioral treatment for avoidant/restrictive food intake disorder in the context of disorders of gut-brain interaction: Initial feasibility, acceptability, and clinical outcomes.The International journal of eating disorders · 2023Observational
- FODMAPs-Do they really affect IBS symptoms?Frontiers in medicine · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
backgroundIrritable bowel syndrome (IBS) is a heterogeneous disorder of gut-brain interaction (DGBI) maintained by interacting biological, psychological, and social processes. Interestingly, there are two contrasting yet evidence-based treatment approaches for reducing IBS symptoms: exclusion diets such as those low in fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) and exposure-based cognitive-behavioural therapy (CBT). Exclusion diets recommend patients avoid foods thought to be symptom-inducing, whereas exposure-based CBT encourages patients to expose themselves to foods.
aimsTo address the paradox of conceptually opposite exclusion diets and exposure-based CBT for IBS.
methodsIn this conceptual review, we describe the rationale, practical implementation, evidence base and strengths and weaknesses of each treatment. We conducted up-to-date literature search concerning the low FODMAP diet and CBT, and performed a secondary analysis of a previously conducted trial to illustrate a key point in our review.
resultsThe low FODMAP diet has demonstrated efficacy, but problems with adherence, nutritional compromise, and heightened gastrointestinal-specific anxiety raise caution. Exposure-based CBT has demonstrated efficacy with substantial evidence for gastrointestinal-specific anxiety as a key mechanism of action. Mediation analysis also showed that increased FODMAP intake mediated decreased symptom severity in exposure-based CBT. However, there is minimal evidence supporting which treatment "works best for whom" and how these approaches could be best integrated.
conclusionsEven though exclusion diets and exposure-based CBT are conceptually opposite, they each have proven efficacy. Clinicians should familiarise themselves with both treatments. Further research is needed on predictors, mechanisms and moderators of treatment outcomes.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.