The low-FODMAP diet and the gluten-free diet in the management of functional abdominal bloating and distension

Abstract

This review summarizes current knowledge on the role of low-FODMAP diet and gluten-free diet in functional abdominal bloating and distension, an emerging disorder of gut-brain interaction characterized by remarkable costs for healthcare systems and a significant impact on the patient’s quality of life. Ingested food plays a key role in the pathophysiology of disorders of gut-brain interaction as up to 84% of patients with irritable bowel syndrome (IBS) report food-triggered symptoms. Potential pathogenetic mechanisms of food-related symptoms in these patients are discussed, focusing on bloating and abdominal distension. These mechanisms provide the rationale for dietary treatment in patients with functional abdominal bloating and distension. The role of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) and gluten in functional abdominal bloating and distension is examined. Current literature evaluating the efficacy of the low-FODMAP diet and the gluten-free diet in abdominal bloating and distension is analyzed. Available evidence originates mainly from studies on patients with IBS, since clinical studies on selected cohorts of patients with only functional abdominal bloating and distension have been missing to date. Promising evidence on the potential efficacy of the low-FODMAP diet in functional abdominal bloating and distension is provided by the reduction of the bloating observed in patients with IBS. Regarding the gluten-free diet, there is insufficient evidence to recommend it to reduce bloating and abdominal distension. In conclusion, this review asserts the need for a close collaboration with experts in nutrition to optimize the management of these patients and reduce the risks associated with elimination diets.

Celiac Disease and Disorders of Gut–Brain Interaction: What School Nurses Need to Know

“…DGBIs are quite prevalent and affect approximately 40% of the population in the world (Sperber et al, 2021). DGBIs were previously termed functional gastrointestinal disorders or functional abdominal pain disorders and include conditions such as infant colic, functional dyspepsia, irritable bowel syndrome, and abdominal migraines (Nurko et al, 2022; Pessarelli et al, 2022; Thapar et al, 2020). DGBIs are characterized by chronic abdominal pain and altered bowel movements, including both diarrhea and constipation; however, no underlying structural abnormality exists in the gastrointestinal tract (Murray et al, 2022; Rexwinkel et al, 2022).…”

“…The causes and pathophysiology of DGBIs are not well understood and are thought to be multifactorial. Psychological factors such as stress, food sensitivities, genetics, and/or altered gut microbiota have been implicated as possible causes (Pessarelli et al, 2022; Rexwinkel et al, 2022). What is known is that DGBIs are prevalent in the pediatric population and a frequent complaint of chronic abdominal pain and symptoms (Pessarelli et al, 2022; Rexwinkel et al, 2022; Thapar et al, 2020).…”

“…Those with abdominal migraines may also experience nausea, vomiting, headache, and photophobia (Thapar et al, 2020). Possible risk factors for DGBIs include a predominance of female sex assigned at birth, a history of mental health concerns including anxiety and depression, and a family history of functional abdominal pain disorders such as irritable bowel syndrome (Pessarelli et al, 2022; Thapar et al, 2020). The relationship between the gut–brain axis is complex; stress and stressful events are thought to have a role in this relationship through the stress response which is regulated by the hypothalamic-pituitary system (Thapar et al, 2020).…”

“…Given the complexity of the biopsychosocial factors associated with DGBIs, treatment modalities are multifaceted and include dietary modifications, nonpharmacologic interventions including cognitive-behavioral therapy, and a range of pharmacological agents (Pessarelli et al, 2022; Rexwinkel et al, 2022). Dietary interventions may be helpful for those individuals with DGBIs who have symptoms induced by food or meal intake; however, clear evidence is lacking on whether specific diets are useful (Pessarelli et al, 2022).…”

“…Given the complexity of the biopsychosocial factors associated with DGBIs, treatment modalities are multifaceted and include dietary modifications, nonpharmacologic interventions including cognitive-behavioral therapy, and a range of pharmacological agents (Pessarelli et al, 2022; Rexwinkel et al, 2022). Dietary interventions may be helpful for those individuals with DGBIs who have symptoms induced by food or meal intake; however, clear evidence is lacking on whether specific diets are useful (Pessarelli et al, 2022). Dietary approaches may include increasing fiber, adding in probiotics or digestive enzymes, or the use of special diets such as the GF diet, a lactose-free diet, or the low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPS) diet (Nurko et al, 2022; Thapar et al, 2020).…”