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The role of fibre in the pathophysiology of irritable bowel syndrome remains poorly understood. An increase in the amount of dietary fibre is an almost universal recommendation in the primary care management of irritable bowel syndrome, and guidelines on irritable bowel syndrome management for out-clinic patients advise an increase in fibre intake in the event of constipation. However, our review showed only limited support for this recommendation.

In summary, our systematic review demonstrates the effectiveness of fibre therapy in irritable bowel syndrome patients, but only in terms of either global symptom improvement or constipation. The effectiveness on individual symptoms is variable. There is no effect of fibre in irritable bowel syndrome-related abdominal pain. Soluble and insoluble fibre have different effects on global irritable bowel syndrome symptoms. Insoluble fibre is probably no better than placebo and may, in some patients, even worsen the clinical outcome. For the development of evidence-based management guidelines, valid clinical studies in primary care patients, focusing on the effectiveness and tolerability of soluble and insoluble fibre, are needed.

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