Clinical effectiveness and economic costs of group versus one‐to‐one education for short‐chain fermentable carbohydrate restriction (low <scp>FODMAP</scp> diet) in the management of irritable bowel syndrome

Whigham, Leah D.; Joyce, Triona; Harper, Gregory S.; Irving, Peter M; Staudacher, Heidi M; Whelan, Kevin; Lomer, Miranda

doi:10.1111/jhn.12318

Cited by 81 publications

(141 citation statements)

References 38 publications

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“…Accordingly, it was found that three‐quarters of the patients were strikingly satisfied. Our finding was also evidenced by studies which found that patients were fairly satisfied, even those who underwent group education and not one‐on‐one sessions 18, 21…”

Section: Discussionsupporting

confidence: 75%

Low FODMAP diet in Egyptian patients with Crohn's disease in remission phase with functional gastrointestinal symptoms

et al. 2018

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Background and AimDespite being in remission, functional gastrointestinal disease (FGID) in Crohn's disease (CD) patients can reduce their quality of life. The Egyptian daily diet contains a high amount of FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols). As the low FODMAP diet has been proven to be effective in irritable bowel syndrome worldwide, it was reasonable to take a step further and begin to study the effect of low FODMAP in Egyptian CD patients with FGID. The outcomes were assessed in terms of improvement in symptoms and hence the quality of life, and the factors that led to this improvement were also recorded.MethodsIn total, 100 CD patients with FGID in the remission stage who were already on a low‐fiber diet (± lactose‐free diet) were selected to follow the low FODMAP diet. A structured interview was performed after 3 months with a number of scored‐scale questionnaires comparing symptoms before and after the diet and the impact on quality of life. Evaluation of the adherence, satisfaction, palatability, and affordability of the diet was performed. Different demographic data were also evaluated in correspondence with improvements in the quality of life.ResultsThe mean score of FGID improvement was 38.45 ± 21.56%. The quality of life was significantly improved; 90% of female patients versus 49.4% males had a better quality of life. The households (not working) as well as those with morning jobs (6 hours) reported an increase in quality of life. Although the Egyptian low FODMAP diet was expensive (in terms of gluten‐free wheat), 67% were adherent to it (18.16 ± 6.85).ConclusionAs a first step in Egypt, the low FODMAP diet was effective in improving the quality of life of CD patients with FGID.

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Section: Discussionsupporting

confidence: 75%

Low FODMAP diet in Egyptian patients with Crohn's disease in remission phase with functional gastrointestinal symptoms

et al. 2018

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“…Dietitian-patient consultations are usually managed using one-on-one meetings, but group consultations may also be equally effective and more cost-effective. 25 A strict low FODMAP diet is generally prescribed by a dietitian for 2-6 weeks after which a steady re-introduction phase is followed, and closely monitored, until a balance between tolerated doses and symptom control is achieved. Dietitians in this area have the expertise not only to educate patients on which foods to consume and those to avoid, but also how to add flavor to their foods and how to interpret food labels/ingredients lists.…”

Section: Implementation Of the Low Fodmap Dietmentioning

confidence: 99%

“…Experience of the diet is growing in many centres. 10,13,25 Details of the types of studies and their specific results are shown in the Table. Such studies as well as those published in abstract form were subjected to a recent meta-analysis and systematic review, with the conclusion that the diet is effective in patients with IBS. 28 The outcomes of such studies have also prompted the increasing need to translate the diet for practical use by other countries.…”

Section: Efficacy Of the Low Fodmap Dietmentioning

confidence: 99%

“…28 The outcomes of such studies have also prompted the increasing need to translate the diet for practical use by other countries. 25 The greatest improvement in overall gastrointestinal symptoms appears to occur within 7 days of adhering to a low FODMAP diet, after which symptoms remain relatively constant. 10,29,30 This rapid improvement is likely to be the result of osmotic and motility changes in the gut.…”

Section: Efficacy Of the Low Fodmap Dietmentioning

confidence: 99%

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The Low FODMAP Diet and Its Application in East and Southeast Asia

Iacovou

Tan

Muir

et al. 2015

J Neurogastroenterol Motil

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There is growing interest in using food choice/dietary change to influence clinical outcomes in patients with irritable bowel syndrome (IBS). The low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) diet is an evidence-based approach that is gaining popularity in many Western countries. The low FODMAP diet is based on restricting dietary intake of short chain carbohydrates that are slowly absorbed or indigestible and not absorbed during passage through the small intestine. These are collectively described as "FODMAPs" and comprise oligosaccharides (mostly fructans, galacto-oligosaccharides), sugar polyols, fructose in excess of glucose, and lactose in lactose malabsorbers. The general strategy of the diet is to avoid foods high in FODMAPs and replace them with foods low in FODMAPs, with long-term restriction limited to what is required to control symptoms. The likely mechanism of action is minimisation of the stimulation of mechanoreceptors exerted by distension of the intestinal lumen with water from osmotic effects and gases from bacterial fermentation in those with visceral hypersensitivity. The success of this dietary approach greatly depends on detailed knowledge about the FODMAP composition of food commonly consumed in that country. While the content of foods associated with East and Southeast Asian cuisines has not been fully explored, major high FODMAP sources are frequently used and include onion, garlic, shallots, legumes/pulses, and wheat-based products. Thus, this dietary approach holds great promise in treating IBS patients in East and Southeast Asia. The aim of this review is to highlight how the diet is implemented, its efficacy, and troublesome ingredients frequently used in Asian dishes.

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“…Previous studies have established the importance of offering education, information and general support in the management of IBS. Given individually or to a group, (38,45) advice and guidance on FODMAP restriction is a cost-effective therapy in the management of IBS-related bloating. Nevertheless, the ideal mode and medium for patient education remain debatable.…”

Section: Differential Effect Of Fodmap Typesmentioning

confidence: 99%

Restriction of FODMAP in the management of bloating in irritable bowel syndrome

Wong¹

2016

smedj

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Irritable bowel syndrome (IBS) is a common functional bowel disorder. Up to 96% of IBS patients experience bloating, resulting in poor response to conventional therapies and high consultation rates. Many IBS patients report that food triggers symptoms, particularly diets with poorly absorbed, short-chain carbohydrates, and restrict intake of certain foods to control their symptoms. IBS patients are especially susceptible to an attack due to visceral hypersensitivity. An emerging therapeutic strategy excludes fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) from the diet. There is evidence supporting the efficacy of a low FODMAP diet in improving symptoms of bloating in IBS patients. Individualised, structured dietary guidance may benefit those with persistent troublesome symptoms despite traditional therapies. In view of the multifactorial aetiology of the condition, it is probably best to use a multipronged approach, involving combination therapies, to address bloating in IBS patients.

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Clinical effectiveness and economic costs of group versus one‐to‐one education for short‐chain fermentable carbohydrate restriction (low FODMAP diet) in the management of irritable bowel syndrome

Abstract: The present study shows that dietitian-led FODMAP group education is clinically effective and the costs associated with a FODMAP group pathway are worthy of further consideration for routine clinical care.

Cited by 81 publications

References 38 publications

Low FODMAP diet in Egyptian patients with Crohn's disease in remission phase with functional gastrointestinal symptoms

Low FODMAP diet in Egyptian patients with Crohn's disease in remission phase with functional gastrointestinal symptoms

The Low FODMAP Diet and Its Application in East and Southeast Asia

Restriction of FODMAP in the management of bloating in irritable bowel syndrome

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