A Low FODMAP Diet Reduces Symptoms in Treated Celiac Patients With Ongoing Symptoms–A Randomized Controlled Trial

Megen, Frida van; Skodje, Gry Irene; Lergenmuller, Simon; Zühlke, Stephanie; Aabakken, Lars; Veierød, Marit Bragelien; Henriksen, Christine; Lundin, Knut E.A.

doi:10.1016/j.cgh.2022.01.011

Cited by 29 publications

(27 citation statements)

References 42 publications

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“…Persistent gastrointestinal symptoms in coeliac disease frequently resemble irritable bowel syndrome 66,67 and are often accompanied by malabsorption of dietary FODMAPs such as lactose, fructose or fructans (found in onion and garlic) 68 . In two randomised controlled trials, dietary FODMAP reduction rapidly and significantly reduced persistent symptoms and this effect was seen even with modest FODMAP reduction 152,153 . Symptoms can also be caused by comorbid diseases, such as gastroparesis in type 1 diabetes and hypothyroidism or hyperthyroidisim in autoimmune thyroid disease.…”

Section: Non‐responsive/slowly Responsive Coeliac Disease and Refract...mentioning

confidence: 99%

“…68 In two randomised controlled trials, dietary FODMAP reduction rapidly and significantly reduced persistent symptoms and this effect was seen even with modest FODMAP reduction. 152,153 Symptoms can also be caused by comorbid diseases, such as gastroparesis in type 1 diabetes and hypothyroidism or hyperthyroidisim in autoimmune thyroid disease. Reduced rates of mucosal recovery have been associated with more severe damage at diagnosis, older age and, potentially, the use of proton pump inhibitors, non-steroidal antiinflammatory drugs and selective serotonin reuptake inhibitors.…”

Section: Are There Other Medical Causes?mentioning

confidence: 99%

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Review article: Follow‐up of coeliac disease

Tye–Din

2022

Aliment Pharmacol Ther

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Coeliac disease is a lifelong immune-mediated enteropathy associated with important systemic manifestations. 1,2 A strict gluten-free diet (GFD) is the cornerstone of management but does not resolve the underlying immune cause of coeliac disease. 3 The GFD imparts a substantial treatment burden, 4 and many patients fail to achieve complete symptom or mucosal remission. As coeliac disease is associated with increased morbidity and modestly increased mortality, periodic medical follow-up is considered a crucial component of patient care [5][6][7][8] but this is compromised by the paucity of evidence to inform best-practice approaches. 9,10 As a result, real-world follow-up is often inconsistent or absent altogether. [11][12][13] For many chronic illnesses, such as type 1 diabetes, the importance of maintaining long-term follow-up to assess disease status, treatment efficacy and monitor for complications is well established in the medical community, however, for coeliac disease, this is typically not the case, even though the monitoring goals are the same. 5,6,7,8,14 For patients, the key goals of treatment are to resolve symptoms, reduce the risk of complications and achieve optimal quality of life, and for clinicians, disease remission also encompasses healing of the enteropathy. Effective models of care that leverage local medical and allied health expertise, ideally involving a gastroenterologist, dietitian and primary care provider, will support these goals but willThe Handling Editor for this article was Professor Peter Gibson, and it was accepted for publication after full peer-review.

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Section: Non‐responsive/slowly Responsive Coeliac Disease and Refract...mentioning

confidence: 99%

Section: Are There Other Medical Causes?mentioning

confidence: 99%

Review article: Follow‐up of coeliac disease

Tye–Din

2022

Aliment Pharmacol Ther

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“…Functional gastrointestinal symptoms may coexist with other gastrointestinal disorders such as coeliac disease and inflammatory bowel disease (IBD). One uncontrolled trial in 25 people and one RCT in 70 people in coeliac disease with persisting symptoms and histologically normal villi-reported gastrointestinal symptom improvement in response to a low FODMAP diet [35,36 ▪ ]. In IBD, intakes of total FODMAPs, fructans and sorbitol are lower in people with active disease, even when adjusted for total energy intake [37 ▪ ].…”

Section: Low Fodmap Diet In Other Gastrointestinal Disordersmentioning

confidence: 99%

Low FODMAP diet in irritable bowel syndrome: a review of recent clinical trials and meta-analyses

Whelan

Staudacher

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewThe low fermentable oligosaccharides, disaccharides, monosaccharides and polyol (FODMAP) diet is widely used in the dietary management of irritable bowel syndrome (IBS). The aim of this review is to summarize recent evidence regarding the use of the low FODMAP diet in IBS and other gastrointestinal disorders from recent clinical trials and meta-analyses.Recent findingsSeveral recent systematic reviews and meta-analyses support the use of low FODMAP restriction for global symptoms in IBS in the short term. Uncontrolled follow-up studies show that at least 50% of individuals experience symptom relief following restriction, reintroduction and personalization in the long term. Although evidence from comparative trials in IBS suggests potential benefit of less burdensome approaches (e.g. standard IBS diet and low lactose diet) many studies are insufficiently powered. One established mechanism is colonic gas production that may induce pain signalling measurable in the brain, however altered gastrointestinal epithelial integrity and shifts in microbiome composition and function may also be involved.SummaryQuality trials of the low FODMAP diet are emerging and have been transformational in supporting the widespread application to IBS management in some areas (e.g. short-term effectiveness), whereas other areas still require considerable improvements in research evidence (e.g. long-term effectiveness, mechanisms and educational delivery).

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“…They went on to demonstrate a high prevalence of carbohydrate malabsorption among individuals post colectomy and to document a significant clinical response to a low FODMAP diet among those who did not have pouchitis. Although a low FODMAP diet continues to be advocated for IBS-like symptoms in quiescent inflammatory bowel disease (IBD) [8 ▪▪ ], and has also shown efficacy in relieving similar symptoms among subjects whose celiac disease is in apparent remission [9 ▪ ], the major focus for the low FODMAP diet quickly shifted to IBS. This was timely given an increasing interest in the role of luminal phenomena in IBS pathophysiology.…”

Section: The Fermentable Oligosaccharides Disaccharides Monosaccharid...mentioning

confidence: 99%

Gastrointestinal effects of diets low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols

Quigley¹

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review Food ingestion is an exacerbator of gastrointestinal symptoms, regardless of origin. Sufferers mistakenly assume that they have suffered an allergic reaction to a given food. Although classical IgE-mediated allergic reactions are rarely culpable, evidence for a role for intolerance to certain carbohydrates in irritable bowel syndrome (IBS) and related conditions increases. This review assesses the status of a commonly implicated group of poorly absorbed carbohydrates (fermentable oligosaccharides, disaccharides, monosaccharides and polyols – FODMAPs) in gastrointestinal pathophysiology. Recent findings Although evidence of efficacy for low FODMAP diets in IBS accumulates, the magnitude of this effect has declined in recent studies. Comparisons to other dietary approaches have revealed conflicting results; some suggest superiority, others find parity. Concerns had been raised regarding long-term nutritional, psychological and microbiological impacts of FODMAP restriction; providing that the diet is administered in the recommended manner, these do not appear to be clinically important. The mechanisms whereby FODMAPs cause gastrointestinal symptoms continue to be explored. Summary FODMAPS induce gastrointestinal symptoms in susceptible individuals and their restriction provides clinical benefits. The magnitude of these benefits, the superiority of FODMAP restriction over other dietary approaches and the mechanisms of its effects continue to be defined.

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A Low FODMAP Diet Reduces Symptoms in Treated Celiac Patients With Ongoing Symptoms–A Randomized Controlled Trial

Cited by 29 publications

References 42 publications

Review article: Follow‐up of coeliac disease

Review article: Follow‐up of coeliac disease

Low FODMAP diet in irritable bowel syndrome: a review of recent clinical trials and meta-analyses

Gastrointestinal effects of diets low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols

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