Epigastric symptom response to low FODMAP dietary advice compared with standard dietetic advice in individuals with functional dyspepsia

Abstract

Background: Certain dietary constituents may provoke symptoms of functional dyspepsia (FD); however, there is an absence of dietary trials testing specific dietary interventions. Empirically derived dietary strategies and the low FODMAP diet are frequently used in practice. This study aimed to compare the effectiveness of low FODMAP dietary advice with standard dietary advice for reducing epigastric and overall gastrointestinal symptoms in individuals with FD. Methods: Data were collected from 59 consecutive eligible individuals with FD attending an initial and review outpatient dietetic consultation at Princess Alexandra Hospital. Of these, 40 received low FODMAP advice and 19 received standard dietary advice. As part of usual care, the Structured Assessment of Gastrointestinal Symptom Scale (SAGIS) was used to assess epigastric (maximum score = 28) and overall gastrointestinal symptoms (maximum score = 88). Dietary adherence data were collected, and change in symptom score and proportion of responders (defined as a ≥30% reduction in score) for epigastric and total symptoms was calculated.Key Results: Most individuals (48/59, 81%) had FD and coexisting irritable bowel syndrome. There was a greater reduction in epigastric score in those receiving low FODMAP dietary advice compared with those receiving standard advice (est. marginal mean [95% CI]: −3.6 [−4.9, −2.2] vs. −0.9 [−2.9, 1.1], p = 0.032) and total symptom score (−9.4 [−12.4, −6.4] vs. −3.3 [−7.7, 1.1] p = 0.026). A greater proportion receiving low FODMAP dietary advice were responders versus those receiving standard advice (50% vs. 16%, p = 0.012). Dietary adherence did not differ between groups (p = 0.497). Conclusions & Inferences:The low FODMAP diet appears more effective for improving epigastric symptoms in people with FD compared with standard advice. A randomized controlled trial is required to substantiate these findings.

Exclusion Diets in Functional Dyspepsia

“…Additionally, Staudacher et al evaluated the link between low FODMAP diet and FD symptom relief [ 24 ]. The study included a total of 59 patients diagnosed with FD, however, a vast majority (81%) were also diagnosed with irritable bowel syndrome.…”

“…Epigastric and overall gastrointestinal symptoms were evaluated using Structured Assessment of Gastrointestinal Symptom Scale (SAGIS). Although adherence to the specific diets did not differ between groups, here was a significant reduction in both epigastric score and total symptom score in the low FODMAP group compared with the standard diet group ( p = 0.026), resulting in a high proportion of responders in the low FODMAP diet group ( p = 0.012) [ 24 ].…”

“…The quality assessment of the included studies is outlined in Supplementary File (Tables S1–S4) . Overall, six studies were rated as “Good” [ 24 , 25 , 26 , 35 , 36 , 37 ] and two studies were regarded as “Fair” [ 23 , 27 ] quality. All studies considered had adequate statistical methods, correctly assessing outcomes using valid and reliable measures.…”

“…Both case–control studies had adequate definitions, representativeness of cases, selection and definition of controls, and properly assessed the exposure and compared the two groups using proper statistical methods [ 24 , 37 ]. We have also included one before-and-after study with no control group [ 27 ] and one cross-sectional one in our systematic review, whose quality was assessed using the NHLBI Quality Assessment and NOS tools, being rated as “Fair” and “Good”, respectively [ 25 ].…”

Evidence-Based and Emerging Dietary Approaches to Upper Disorders of Gut–Brain Interaction

“…In FD, a small number of recently published studies have investigated the therapeutic efficacy of this diet (Table 1 and Figure 1 ). A beneficial effect of a low FODMAP diet compared with standard dietary advice was reported in a cohort of 59 patients with FD, but with 81% having coexisting IBS ( 67 ). Goyal et al ( 68 ) compared the effect of a 4-week low FODMAP diet to traditional dietary advice in a group of 105 patients with Rome IV FD where those with overlapping IBS and other dietary-related conditions (e.g., a history of lactose/fructose intolerance and patients already on restricted diet) were excluded.…”