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Background: Elimination diets have been used in Crohn's disease to help maintain remission following enteral feeding. However, patients often find the strict regimen difficult to follow resulting in poor compliance. This paper describes the development and evaluation of an alternative method of food re-introduction, a low-fibre, fat-limited exclusion diet or 'LOFFLEX' diet. Methods: Patients achieving remission on an elemental or peptide feed or total parenteral nutrition (TPN) chose to follow either an elimination or LOFFLEX diet. Their progress was assessed regularly and life-analysis tables used to calculate remission rates for the two groups at the end of a 2-year period. Results: In a series of 76 treatment episodes (74 patients having achieved remission on an enteral feed, two on TPN), 28 patients (37%) chose the elimination diet and 48 (63%) the LOFFLEX diet. Fourteen per cent failed to comply with the elimination diet and 8% failed to comply with the LOFFLEX diet. Eleven per cent of the elimination group and 12.5% of the LOFFLEX group relapsed immediately and were all found to have tight strictures. At 24 months, the proportion of compliant, non-strictured patients still in remission was 59% for the elimination diet and 56% for the LOFFLEX diet. Conclusion: This study suggests that the LOFFLEX diet has a similar efficacy to the elimination diet whilst being more acceptable to the patient. A randomized, prospective controlled study is now underway to further investigate these findings.

Correspondence T. Woolner,Introduction High-fibre diets are frequently advocated for the treatment of irritable bowel syndrome (IBS) although there is little scientific evidence to support this. Experience of patients on low-fibre diets suggests that this may be an effective treatment for IBS, warranting investigation.Methods Symptoms were recorded for 204 IBS patients presenting in the gastroenterology clinic. They were then advised on a low-fibre diet with bulking agents as appropriate. Symptoms were reassessed by postal questionnaire 4 weeks later. Patients who had improved on the diet were advised on the gradual reintroduction of different types of fibre to determine the quantity and type of fibre tolerated by the individual.Results Seventy-four per cent of questionnaires were returned. A significant improvement (60±100% improvement in overall well-being) was recorded by 49% of patients.Conclusion This preliminary study suggests that low-fibre diets may be an effective treatment for some IBS patients and justifies further investigation as a full clinical trial.

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