We thank Drs Katzenstein and Keefer for their editorial on our paper [1, 2]. We fully agree on the need for progress towards an integrated, personalised model of care for patients with disorders of gut-brain interaction. We are aware of the limitations of the Hospital Anxiety and Depression Scale (HADS) and concur that it does not capture all the psychological nuances seen in patients with irritable bowel syndrome (IBS). However, it is easily understood and administered by non-specialist practitioners and has been used across a range of DGBIs by others [3]. Although the imperative for the development of symptom-specific questionnaires, specific psychosocial questionnaires and inclusion of psychosocial well-being have been championed by expert opinion, none was in use at the time of our study, and none has since emerged [4].

As the study was conducted in routine clinical practice and at the time of the Coronavirus pandemic, many patients were consulted with remotely. We believed it would have been difficult to repeat the HADS post-intervention. In addition, around the time of lockdown restrictions related to the pandemic, observed incidences of anxiety and depression were increased [5]. In such a setting, to infer that any changes observed in HADS over the period of the intervention were due to dietary therapy or IBS symptom status alone may have been an over-simplification.

The vast majority of patients with IBS are, and will continue to be, treated in primary and secondary care by either generalist physicians and dietitians or others with a subspeciality interest in the field. We, therefore, contend that the design and findings of our study are broadly generalisable to existing models of care and show promising results even in patients with more severe symptoms, overlapping symptomatology and poor psychological health, which will resonate with clinical practitioners across disciplines. Like Drs Katzenstein and Keefer, we look forward to the type of studies that will lead to greater comprehension of the intersection of food and mood, and to uncover the underlying mechanisms at play. Until then, evidence from studies such as our own—that may improve understanding of how psychological parameters could predict response to commonly used interventions—is an important step towards personalising care for patients with IBS.

我们感谢 Katzenstein 博士和 Keefer 博士对我们论文的社论 [1， 2]。我们完全同意需要为肠脑相互作用障碍患者建立综合、个性化的护理模式。我们意识到医院焦虑和抑郁量表 （HADS） 的局限性，并同意它没有捕捉到肠易激综合征 （IBS） 患者的所有心理细微差别。然而，非专业医生很容易理解和管理它，并且已被其他人用于一系列 DGBI [3]。尽管专家意见支持开发症状特异性问卷、特定社会心理问卷和纳入社会心理健康的必要性，但在我们研究时没有使用，此后也没有出现 [4]。

由于该研究是在常规临床实践中进行的，并且在冠状病毒大流行期间，许多患者被远程咨询。我们认为干预后很难重复 HADS。此外，在与大流行相关的封锁限制期间，观察到的焦虑和抑郁的发生率有所增加 [5]。在这种情况下，推断在干预期间观察到的 HADS 的任何变化仅是由于饮食疗法或 IBS 症状状态可能过于简单化。

绝大多数 IBS 患者正在并将继续接受全科医生和营养师或其他对该领域有亚专业兴趣的人在初级和二级保健中的治疗。因此，我们认为，我们研究的设计和发现可以广泛推广到现有的护理模式，并且即使在症状更严重、症状重叠和心理健康状况不佳的患者中也显示出有希望的结果，这将引起跨学科临床从业者的共鸣。与 Katzenstein 和 Keefer 博士一样，我们期待着这种研究类型，这将使人们更好地理解食物和情绪的交集，并揭示起作用的潜在机制。在此之前，来自我们等研究的证据——可能会提高对心理参数如何预测对常用干预措施的反应的理解——是为 IBS 患者提供个性化护理的重要一步。