Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease

Abstract

AIMTo investigate the effect of a low-FODMAP diet on irritable bowel syndrome (IBS)-like symptoms in patients with inflammatory bowel disease (IBD).METHODSThis was a randomised controlled open-label trial of patients with IBD in remission or with mild-to-moderate disease and coexisting IBS-like symptoms (Rome III) randomly assigned to a Low-FODMAP diet (LFD) or a normal diet (ND) for 6 wk between June 2012 and December 2013. Patients completed the IBS symptom severity system (IBS-SSS) and short IBD quality of life questionnaire (SIBDQ) at weeks 0 and 6. The primary end-point was response rates (at least 50-point reduction) in IBS-SSS at week 6 between groups; secondary end-point was the impact on quality of life.RESULTSEighty-nine patients, 67 (75%) women, median age 40, range 20-70 years were randomised: 44 to LFD group and 45 to ND, from which 78 patients completed the study period and were included in the final analysis (37 LFD and 41 ND). There was a significantly larger proportion of responders in the LFD group (n = 30, 81%) than in the ND group (n = 19, 46%); (OR = 5.30; 95%CI: 1.81-15.55, P < 0.01). At week 6, the LFD group showed a significantly lower median IBS-SSS (median 115; inter-quartile range [IQR] 33-169) than ND group (median 170, IQR 91-288), P = 0.02. Furthermore, the LFD group had a significantly greater increase in SIBDQ (median 60, IQR 51-65) than the ND group (median 50, IQR 39-60), P < 0.01.CONCLUSIONIn a prospective study, a low-FODMAP diet reduced IBS-like symptoms and increased quality of life in patients with IBD in remission.

Content of Poorly Absorbed Short‐Chain Carbohydrates (FODMAP) in Enteral Homemade Diets

“…In addition, bacterial fermentation results in the production of short‐chain fatty acids and reduction of the luminal pH, presenting beneficial effects to the host . In contrast, individuals with digestive impairment and problems with the absorption of these carbohydrates frequently exhibit intolerance to foods rich in FODMAP, presenting abdominal distension, colic, and diarrhea, among other intestinal symptoms, which affect their quality of life . In this way, the blenderized whole‐food enteral diet, which has a low FODMAP content, offers an effective approach in the management of patients receiving ENT who have functional intestinal symptoms …”

Dietary therapies for functional bowel symptoms: Recent advances, challenges, and future directions

“…Whether these differences were related to poorly controlled symptoms on the gluten‐free diet, or due to the restrictions of the diet itself are unknown. The low FODMAP diet has shown positive improvements to quality of life in patients with IBS compared to those not receiving dietary therapy, compared to a modified NICE diet, and in IBD patients compared to those receiving a normal diet . Using the interference with life in general data from the IBS‐severity scoring system, one study showed improvement on the low FODMAP diet compared to baseline .…”

“…With the high frequency of IBS symptoms in quiescent IBD, the low FODMAP diet is now being integrated into clinical practice for control of functional symptoms in IBD patients. A small body of evidence suggests similar benefits in quiescent IBD patients as seen with IBS . However, theoretical concern exists for the potential lowering of SCFA with use of the low FODMAP diet, as reduced SCFA has been implicated in increasing susceptibility to colitis in mice .…”

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

“…Further studies could be conducted in order to explore this aspect. Second, it could be valuable to conduct further research on the long-term effects of the dietetic regimen: in our work, we estimated a follow-up of 3 months as recommended by major studies [12, 13, 20]. On the other hand, several studies evaluated the role of a low FODMAP diet in the short term (<4 weeks) [39, 45].…”

“…Most clinical studies in literature have demonstrated the effectiveness of a low FODMAP diet in reducing intestinal symptoms in patients with IBS [10-12]. …”