Title : Integrative medicine for disorders of gut-brain interaction: evidence-based approaches in irritable bowel syndrome
Abstract:
Disorders of gut-brain interaction (DGBIs), including irritable bowel syndrome (IBS), are among the most prevalent gastrointestinal conditions and are characterized by complex interactions between the enteric nervous system, central nervous system, gut microbiome, immune pathways, and psychosocial factors. Conventional pharmacologic therapies provide modest benefits for many patients, leading increasing numbers to seek integrative approaches that address multiple dimensions of disease pathophysiology.
This presentation reviews the current evidence supporting integrative therapies for IBS and other DGBIs, with emphasis on lifestyle, behavioral, dietary, and complementary interventions. Among available modalities, gut-brain behavioral therapies, including cognitive behavioral therapy, gut-directed hypnotherapy, relaxation training, and mindfulness-based interventions, demonstrate the strongest evidence for improving global symptoms and quality of life, with benefits that often persist beyond active treatment. Mind-body interventions such as yoga and diaphragmatic breathing may provide additional symptom relief through modulation of autonomic function and visceral hypersensitivity.
Dietary and nutraceutical therapies also play an important role in integrative management. Soluble fiber, particularly psyllium, remains one of the most consistently supported nonpharmacologic treatments, while emerging evidence suggests that fiber-rich foods such as kiwifruit and prunes may provide comparable benefits for constipation-predominant symptoms. Peppermint oil has demonstrated efficacy for abdominal pain and global IBS symptoms and remains one of the best-supported botanical therapies. Evidence for probiotics continues to evolve, with potential benefits appearing strain-specific, although current guideline recommendations remain cautious because of heterogeneity among studies. Physical activity is associated with broader health benefits and may improve IBS symptom severity, although further research is needed to define optimal exercise prescriptions.
Additional complementary therapies, including acupuncture, show promising but mixed results, while evidence for Ayurvedic formulations and digestive enzymes remains limited. Overall, current data support a patient-centered integrative framework that combines lifestyle modification, dietary therapy, gut-brain behavioral interventions, and selective evidence-based supplements alongside conventional medical care. This approach aligns with the biopsychosocial model of DGBIs and offers clinicians practical strategies to improve symptom control, quality of life, and long-term patient outcomes.
