S731 The Impact of Non-Nutritive Sweeteners on Irritable Bowel Syndrome Symptoms: A Systematic Review

Introduction: Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder marked by abdominal pain, bloating, and altered bowel habits. Non-nutritive sweeteners (NNS) such as sucralose, stevia, sorbitol, and mannitol are widely used as sugar substitutes to reduce caloric intake. However, concerns have emerged regarding their potential to worsen gastrointestinal symptoms, especially in individuals with IBS. This systematic review evaluates the effects of NNS on IBS symptoms, emphasizing their fermentability and impact on gut microbiota. Methods: A systematic search was conducted using Ovid MEDLINE, Ovid Embase, and Cochrane Central databases to identify studies examining the relationship between NNS and IBS symptoms. Included studies assessed NNS fermentability, hydrogen breath test (HBT) results, gut microbiota alterations, and clinical outcomes in IBS patients. Eligible studies were clinical trials, pilot studies, and observational studies exploring gastrointestinal effects of NNS, particularly bloating, diarrhea, and abdominal pain. Results: Findings revealed that fermentable NNS, particularly sugar alcohols like sorbitol and mannitol, undergo colonic fermentation and exacerbate IBS symptoms. Approximately 36.4% of patients demonstrated fermentation of sucralose and stevia, with associated symptoms of bloating, abdominal pain, and diarrhea which were more pronounced in IBS patients than in healthy controls. NNS consumption was also associated with gut dysbiosis and increased production of hydrogen and methane on breath testing, correlating with symptom severity. Diets high in NNS were associated with exacerbations of diarrhea, constipation, and postprandial discomfort, whereas symptom relief was noted following NNS exclusion. Conclusion: This review highlights the role of fermentable NNS in aggravating IBS symptoms through gut fermentation and alterations in the microbiota. Notably, sugar alcohols such as sorbitol and mannitol appear to contribute significantly to bloating, abdominal pain, and diarrhea in IBS patients. Eliminating NNS from the diet has been associated with symptom improvement and better quality of life. However, considerable individual variability exists in response to NNS, suggesting the need for personalized dietary approaches.