Gastroenterology · 2026
Fiber Supplementation in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
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Staudacher Heidi M, Rucco Valeria, Mancell Sara, Dimidi Eirini, Whelan Kevin
Аннотация
BACKGROUND & AIMS: Fiber supplementation is widely used and recommended for irritable bowel syndrome (IBS), however, there is no recent evidence synthesis. We aimed to investigate the efficacy of fiber supplements in IBS through a systematic review and meta-analysis of randomized controlled trials (RCTs).
METHODS: We searched MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (inception to April 9, 2026). Trials that recruited adults with IBS and investigated fiber supplements compared with a suitable placebo control were included. Dichotomous clinical response data were summarized with risk ratios and 95% CIs. The review was registered prospectively on the international systematic review registry PROSPERO (CRD42024600758).
RESULTS: The search identified 4008 records and 30 RCTs including 1904 people with IBS were eligible. The most common fiber types were wheat bran (n = 7), psyllium (n = 6), inulin-type fructans (n = 5), and β-galacto-oligosaccharides (n = 2); 2 RCTs used fiber co-administration. Sixteen RCTs (n = 1293) reported the clinical response; 52% responded to fiber vs 44% to control (risk ratio, 1.21; 95% CI, 1.03 to 1.41; P = .02; I2 = 38%), with a benefit for psyllium specifically (risk ratio, 1.53; 95% CI, 1.06 to 2.19). Nine RCTs (n = 497) reported overall GI symptoms (integrative scores) and found no significant effect (standardized mean difference, -0.25; 95% CI, -0.67 to 0.17; P = .25; I2 = 78%) except for β-galacto-oligosaccharides, which improved symptoms. Subgroup analysis for IBS subtype was not possible for most outcomes.
CONCLUSIONS: Fiber supplementation, and psyllium specifically, leads to clinical response in IBS. Future RCTs should report outcomes for individual IBS subtypes or only recruit specific IBS subtypes to better enable identification of distinct patterns of response.
METHODS: We searched MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (inception to April 9, 2026). Trials that recruited adults with IBS and investigated fiber supplements compared with a suitable placebo control were included. Dichotomous clinical response data were summarized with risk ratios and 95% CIs. The review was registered prospectively on the international systematic review registry PROSPERO (CRD42024600758).
RESULTS: The search identified 4008 records and 30 RCTs including 1904 people with IBS were eligible. The most common fiber types were wheat bran (n = 7), psyllium (n = 6), inulin-type fructans (n = 5), and β-galacto-oligosaccharides (n = 2); 2 RCTs used fiber co-administration. Sixteen RCTs (n = 1293) reported the clinical response; 52% responded to fiber vs 44% to control (risk ratio, 1.21; 95% CI, 1.03 to 1.41; P = .02; I2 = 38%), with a benefit for psyllium specifically (risk ratio, 1.53; 95% CI, 1.06 to 2.19). Nine RCTs (n = 497) reported overall GI symptoms (integrative scores) and found no significant effect (standardized mean difference, -0.25; 95% CI, -0.67 to 0.17; P = .25; I2 = 78%) except for β-galacto-oligosaccharides, which improved symptoms. Subgroup analysis for IBS subtype was not possible for most outcomes.
CONCLUSIONS: Fiber supplementation, and psyllium specifically, leads to clinical response in IBS. Future RCTs should report outcomes for individual IBS subtypes or only recruit specific IBS subtypes to better enable identification of distinct patterns of response.