Beyond Irritable Bowel Syndrome: The Efficacy of the Low Fodmap Diet for Improving Symptoms in Inflammatory Bowel Diseases and Celiac Disease

Abstract

Background and Aim: To evaluate the usefulness of a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet on patients with irritable bowel syndrome (IBS), non-active inflammatory bowel diseases (IBD), and celiac disease (CD) on a gluten-free diet (GFD). Methods: Dietetic interventional prospective study. IBS, IBD, and CD subjects were evaluated to check if they fulfilled the Rome III criteria. Each subject was educated to follow a low FODMAP diet after being evaluated by filling out questionnaires that assessed the quality of life (QoL) and symptoms experienced (IBS-SSS and SF-36), and was reevaluated after 1 and 3 months. Results: One hundred twenty-seven subjects were enrolled: 56 with IBS, 30 with IBD, and 41 with CD. IBS-SSS showed that abdominal symptoms improved after 1 and 3 months of diet in all subjects, with significant difference among the 3 groups at T0 (average scores IBS: 293 ± 137, IBD: 206 ± 86, CD: 222 ± 65, p < 0.001), but no difference at T3 (IBS: 88 ± 54, IBD: 73 ± 45, CD: 77 ± 49, p = ns). By analyzing the SF-36 questionnaire, we did not observe any difference between the 3 groups, in terms of response to diet (p = ns), we observed a clinical improvement from T0 to T3 for most of the questionnaire’s domains. Conclusions: A low FODMAP diet could be a valid option to counter ­abdominal symptoms in patients with IBS, non-active IBD, or CD on a GFD, and thus, improve their QoL and social ­relations.

Inadvertent and minimal gluten intake has a negligible role in the onset of symptoms in patients with coeliac disease on a gluten-free diet

“…The involuntary, and undiscovered, ingestion of gluten cannot be considered responsible for the appearance of symptoms in CD patients on a GFD. If these symptoms are clinically relevant, it is therefore necessary to look for their cause as they could be caused either by a condition associated with CD, and not yet discovered, or by one of the fearsome complications of CD (26)(27)(28) . We conclude that the involuntary ingestion of minimal quantities of gluten does not have a role in the origin of symptoms in patients with CD on a GFD.…”

Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease

“…In addition, functional gastrointestinal disorders, such as irritable bowel syndrome (IBS) and gastrointestinal dysmotility, are more prevalent in individuals with CD [23,24] and should not be overlooked as a cause of persisting symptoms in individuals with normal repeat duodenal histology. For these individuals, a low fermentable oligo-, di-, mono-saccharide and polyol (FODMAP) diet may improve symptoms and quality of life [25,26]. In one study, 41 CD patients with IBS who had been on a GFD for at least 1 year demonstrated significant improvement in IBS-symptom severity scores after 3 months on the low FODMAP diet [25].…”

“…For these individuals, a low fermentable oligo-, di-, mono-saccharide and polyol (FODMAP) diet may improve symptoms and quality of life [25,26]. In one study, 41 CD patients with IBS who had been on a GFD for at least 1 year demonstrated significant improvement in IBS-symptom severity scores after 3 months on the low FODMAP diet [25]. The benefits of a low FODMAP diet have also been shown in a recent randomized controlled trial; 50 patients with CD and persisting symptoms were randomized to follow either a regular GFD (R-GFD, n = 25) or a low FODMAP GFD (LF-GFD, n = 25) for 21 days.…”

Evaluation of nutritional adequacy in adult patients with Crohn’s disease: a cross-sectional study

“…Currently, reduced macronutrient intakes are less common in these patients, whereas deficits in micronutrients, such as iron, copper, selenium, magnesium, zinc, vitamins, and antioxidants (vitamins C, E, beta carotene, glutathione, taurine) can occur frequently [8][9][10][11][12][13][14][15][16], even in apparently well-nourished patients [13]. Some food group restrictions, such as dairy products and/or fruit and vegetables, are pursued by patients to control their symptoms [10,17]. Additionally, appetite sensation could dramatically change, especially with active disease, in which patients experience less hunger and more satiety [18].…”