Low-FODMAP Diet for the Management of Irritable Bowel Syndrome in Remission of IBD

Abstract

Approximately 30% of patients with quiescent inflammatory bowel disease (IBD) meet the diagnostic criteria for irritable bowel syndrome (IBS). The aim of this study was to evaluate the effectiveness of a low-FODMAP diet in patients who meet the diagnostic criteria for IBS whilst in IBD remission. A total of 200 patients in remission of IBD were included in the study. Sixty-five of these patients (32.5%) were diagnosed with IBS according to the R4DQ. On the patients who met the IBS diagnostic criteria, anthropometric measurements, laboratory tests and lactulose hydrogen breath tests were performed. A low-FODMAP diet was introduced for 6 weeks. Of the 59 patients with IBS diagnosed at baseline for whom data were collected at the end of follow-up, after the low-FODMAP intervention IBS-like symptoms were not present in 66.1% (n = 39) (95% CI (53.4%; 76.9%)). The difference between the two groups (with SIBO at baseline (33 of 48 patients) and without SIBO at baseline (6 of 11 patients)) in the low-FODMAP diet’s effectiveness was not statistically significant (p = 0.586). The low-FODMAP diet improved the gut symptoms of flatulence and diarrhea. It had no effect on the occurrence of constipation. In IBD patients in remission who meet the IBS criteria, the dietary intervention of a low-FODMAP diet is effective for a reduction in IBS-like symptoms, regardless of the coexistence of bacterial overgrowth.

Effects of a Low-FODMAP Diet on Irritable Bowel Syndrome in Both Children and Adults—A Narrative Review

“…In summary, a low-FODMAP diet (LFD) has been shown to have favourable effects on symptoms of irritable bowel syndrome (IBS), particularly in relieving abdominal pain, bloating, and diarrhoea [ 77 ]. Improvement in bowel movements and stool characteristics has been reported in several studies, with a significant decrease in the number of bowel movements and an increase in stool consistency.…”

Effects of a low FODMAP diet on the symptom management of patients with irritable bowel syndrome: a systematic umbrella review with the meta-analysis of clinical trials

“…In addition, drugs alone are not effective in all cases. 10,11 In this situation, dietary management is considered a treatment option. 12 The majority of IBS patients report the onset or exacerbation of symptoms with some foods.…”

“…3 One of the elimination diets that was recently devised is a low FODMAP diet (LFD), restricting fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). 2,11 These short-chain carbohydrates are present in diverse fruits, vegetables, legumes, dairy products, artificial sweeteners, and foods containing wheat. 3 These are incompletely absorbed in the small intestine and can lead to gas generation, diarrhea, cramping, and flatulence via gut microbial fermentation mostly in the colon, and incremented water maintenance via osmosis in both the colon and the small intestine.…”

“…15 Several studies have approved that the gut microbiota, gut barrier, and visceral sensation are influenced by dietary habits and FODMAPs. 16,17 Recently, gut microbiota-targeted treatment 18 and dietary approaches 11 have been extensively used in clinical practice for the treatment of IBS. 19 According to recent research, following the restriction phase, treatment with Rifaximin and probiotics and diet personalization phase are recommended.…”

“…In addition, drugs alone are not effective in all cases. 10,11 In this situation, dietary management is considered a treatment option. 12…”