What role do dietary modifications play in the management of chronic abdominal pain in primary care?

Dietary modifications play a key role in managing chronic abdominal pain, particularly when related to irritable bowel syndrome (IBS), in primary care. For people with IBS, dietary and lifestyle advice is a first-line management strategy, including having regular meals, avoiding long gaps between eating, and drinking at least 8 cups of fluid daily, mainly water or non-caffeinated drinks. Limiting tea and coffee to 3 cups per day, reducing alcohol and fizzy drinks intake, and moderating high-fibre foods and resistant starch can help reduce symptoms such as abdominal pain and bloating. Fresh fruit intake should be limited to about 3 portions per day ¹.

Soluble fibre supplementation is generally safe, inexpensive, and can improve global IBS symptoms and abdominal pain, whereas insoluble fibre may worsen symptoms and should be avoided ².

Food triggers such as alcohol, caffeine, spicy and fatty foods can exacerbate symptoms by affecting gastrointestinal motility and secretion, so identifying and avoiding these triggers is recommended ².

If general dietary advice is insufficient, referral to a dietitian is advised for further dietary management, including supervised trials of exclusion diets like the low-FODMAP diet, to avoid nutritional deficiencies and ensure a balanced diet ².

For chronic abdominal pain not related to IBS, such as chronic pancreatitis, dietary management includes assessment by a dietitian to address malabsorption and malnutrition risks, with specialist advice on food, supplements, and enzyme replacement therapy as needed ⁴.